NAVY FEDERAL CREDIT UNION PO Box 3000 Merrifield VA Telephone: or FAX:
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1 NAVY FEDERAL CREDIT UNION PO Box 3000 Merrifield VA Telephone: or FAX: PERSONAL FINANCE MANAGEMENT INFORMATION SHEET Date Rec'd _ Due Date Loan Visa _ MasterCard (1) Please complete the following form in detail. (2) Provide a brief explanation of the reasons why you are seeking personal money management assistance. (3) Include all sources of income used to pay expenses shown (part-time jobs, spouse's income, etc). (4) Mail the original of this form, together with a copy of a recent statement or pay stub to Navy Federal at the above address or fax to the number above. (5) KEEP A COPY OF YOUR FILLED-IN PERSONAL FINANCE INFO SHEET. A specialist will telephone you to review it with you and discuss your situation. Optional Mr. RANK/RATE MEMBER'S NAME (FIRST MI LAST) ACCESS NO. Mrs. Miss CURRENT TELEPHONE NUMBER (incl. area code) HOME: ( ) DUTY STATION OR EMPLOYER AND (Use abbreviations) OFFICE: ( ) Ext. RELEASE DATE (Military Only) TIME ON JOB DEPENDENTS (ADULTS & MINORS) MEMBER'S DATE OF BIRTH MEMBER'S SOCIAL SECURITY NO. Month Year NUMBER AGES Indefinite Yrs. Mos. OTHER INCOME NAME OF PERSON & DAYTIME PHONE NO. RELATIONSHIP AGE RESIDING EMPLOYER AND Complete ONLY if relying WITH YOU? on another person's income to repay your obligations. Yes No TYPE OF AUTOMOBILE(S) OWNED (MAKE MODEL YEAR) EQUITY IN REAL ESTATE OTHER ASSETS (TYPE AND APPROXIMATE AMOUNT) CIRCUMSTANCES LEADING TO MY CURRENT FINANCIAL SITUATION ARE: MEMBER'S SIGNATURE NFCU 260 (10-05) Copyright 2005 Navy Federal *260*
2 MONTHLY INCOME MEMBER SPOUSE (Include part-time employment) Gross or Base Pay... _ Part Time Salary... _ Quarters Allowance... Subsistence or COMRATS... Foreign or Sea Pay... Retirement Pay... Child Support/Alimony... Clothing Allowance... Other (Explain)... GROSS MONTHLY INCOME... _ PAYROLL DEDUCTIONS Federal Taxes... _ State Taxes... Social Security (FICA)... Retirement... Insurance (Explain)... Insurance (Explain)... Advance Pay (Date of Final Deduction)... Allotment (Type and Purpose)... Allotment (Type and Purpose)... Union Dues... Other (Explain)... Other (Explain)... TOTAL PAYROLL DEDUCTIONS _ NET MONTHLY INCOME (Take Home Pay) (Gross Monthly Income Minus Total Payroll Deduction)... _ COMBINED NET MONTHLY INCOME (Combined Take Home Pay)... NET INCOME LIVING EXPENSES DISPOSABLE INCOME LIVING EXPENSES Mortgage or Rent (principal, interest, tax, insurance, homeowner's/condo fee)... Utilities (Specify-- gas, oil, coal, electric, garbage, sewage, water)... Telephone, pager, cellular, internet... _ Food (for family of ) (household supplies, cleaning aids, pet costs, disposable diapers)... _ Food costs away from home (work lunches, vending machines, coffee)... _ School Lunches... School/Preschool/Other (tuition, books, music/dancing lessons, supplies)... Child Support/Alimony... Tobacco Products and Alcohol... Auto (gas and oil)... Transportation (other than auto; bus, car pool, taxi)... Clothing and Shoes... Dry Cleaning & Laundry... Medical & Dental (prescriptions, glasses, aspirin, deductible, copay, etc.)... Babysitter/Child or Daycare... Entertainment/Recreation (movies, sports, hobbies, cable T.V., video rental, dining out)... Personal Needs (haircuts, toiletries, shampoo, toothpaste, shaving gear... Miscellaneous (newspaper, charity, allowances stamps, veterinary, storage etc.) Explain... SUBTOTAL... OTHER EXPENSES (Quarterly, Semi-Annually, Annually) Insurance (life, auto, hospital, property)... Taxes (real estate, personal property)... Auto Maintenance (repairs, tags and registration)... House Maintenance (home repairs, yard upkeep)... Gifts (birthdays, holidays, etc.)... Subscriptions (book clubs, magazines, record clubs, CD s)... Clubs (dues, recreation, health, pool fees, associations)... TOTAL OTHER EXPENSES... Amount per Year MONTHLY AVERAGE OTHER EXPENSES (Total Other Expenses divided by 12 mos.) _ TOTAL EXPENDITURES... AMOUNT PER MONTH _
3 THE FOLLOWING IS A LIST OF MY CURRENT CREDITORS SUB TOTAL LIST ADDITIONAL CREDITORS ON REVERSE REMEMBER TO KEEP A COPY OF THIS FORM!
4 THE FOLLOWING IS A LIST OF MY CURRENT CREDITORS TOTAL REMEMBER TO KEEP A COPY OF THIS FORM!
5 EXTENSION AGREEMENT NAVY FEDERAL CREDIT UNION MEMBER'S NAME (FIRST MI LAST) LOAN NO. MEMBER'S REQUEST AND AGREEMENT (to be completed by the member) I request an extension of time to pay off my loan. I understand that if a new payment schedule is approved, Navy Federal Credit Union will return to me a duplicate of this completed agreement showing the new payment schedule. I agree to pay the balance on my loan with interest at the same rate in accordance with the revised payment schedule. I further understand that all other provisions of the original note remain in full force and effect including the accrual of interest. The circumstances necessitating this extension are: MEMBER'S SIGNATURE COSIGNER'S AGREEMENT (to be completed by cosigner(s) if applicable) I agree to this extension of time and/or terms of repayment. I further understand that this extension does not release me from liability towards this debt. SPOUSE/COSIGNER'S SIGNATURE COSIGNER'S SIGNATURE ACKNOWLEDGEMENT (to be completed by owner(s) other than borrower of collateral pledged as security for this loan, if applicable) Owner(s) of collateral other than borrower acknowledge that the provisions of the original Security Agreement apply to this extension of time and/or terms of repayment. SIGNATURE OF OWNER OF OTHER THAN BORROWER CREDIT COMMITTEE ACTION SIGNATURE OF OWNER OF OTHER THAN BORROWER signed a note _ (date of original Promissory Note) in favor of Navy Federal Credit Union in the original amount of _, payable per month. In response to the above request the Credit Committee approves: An extension of _ months to pay off the unpaid principal balance of on this note. Lower monthly payments of beginning. The terms of your loan have been extended to. PRESENT (MO., DAY, YR.) LOAN OFFICER CODE LOAN OFFICER SIGNATURE CREDIT COMMITTEE SIGNATURE CREDIT COMMITTEE SIGNATURE NFCU 138 (4-05) 2005 Navy Federal Credit Union *138*
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