Instructions on the Completion of a Personal Financial Statement

Transcription

1 Instructions on the Completion of a Personal Financial Statement Tab 1: Instructions on how to complete the Personal Financial Statement (PFS) Tab 2: First (1st) page of a sample PFS Tab 3: Second (2nd) page of sample PFS Tab 4: First (1st) page of PFS to be completed by Borrower Tab 5: Second (2nd) page of PFS to be completed by Borrower 1. Complete the second page (TAB 5) first and then fill in the totals from each schedule on page one (TAB 4) where it indicates. 2. Only list those assets and liabilities that are legally titled in your individual name (listed in section 1) or jointly with the Other Party (listed in section 2). 3. If you own real estate or business assets or have debts that are owned by another entity (ex. limited liability company, limited partnership, corporation etc.) list the equity you have in these entities under " Ventures" in the Assets column. 4. Under "Cash Surrender ValueLife Insurance" in the asset column only include the net cash surrender value of the policy (i.e. the amount the insurance company would pay you if you canceled the policy) rather than the death benefit payable to your beneficiary. The death benefit would be listed in Schedule E under "Face Amount". 5. If you have any questions on how to complete the PFS or would like assistance preparing it, please contact any of our business bankers. Contact information for our business bankers can be found at under the /Government tab.

2 Submitted to: Reliance Bank S A M P L E PERSONAL FINANCIAL STATEMENT Date: 10/01/20xz IMPORTANT: Read these directions before completing this Statement If you are applying for individual credit in your own name and are relying on your own income, or assets and not the income or assets of another person as the basis for repayment of the credit requested, or if this statement relates to your guaranty of the indebtedness of other person(s), firm(s), or corporation(s), complete only Sections 1, 3, and 4. If you are applying for individual credit but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as a basis for repayment of the credit requested, complete all Sections. Provide information in Section 2 about the person whose alimony, support, or maintenance payments or income or assets you are relying on. Alimony, child support, or separate maintenance income, need not be revealed if you do not wish to have it considered as a basis for replaying this obligation. Section 1 Individual Information (type or print) Jane Smith 1122 Blue Street Section 2 Other Party Information (type or print) Altoona, PA Social Security #: /01/19xz Dry Cleaning Dry Supply, Inc Red Street Social Security #: Altoona, PA years 20 years Res. Phone: Bus. Phone: Res. Phone: Section 3 Statement of Financial Condition as of Assets (Do not include assets of doubtful value) Cash, Checking & Savings, CD's see Schedule A U.S. Gov't & marketable securities see Schedule B nmarketable securities see Schedule C Securities held by broker in margin accounts Have (either of) you or any firm in which you were a major owner ever declared bankruptcy, or settled any debts for less than the amounts owed? If yes, please provide details on a separate sheet. Are (either of) you a defendant in any suit or legal action? Are (either of) you presently subject to any unsatisfied judgements to tax liens? When, if ever, have (either of) you been audited by IRS? Liabilities tes payable to banks & others $30, see Schedule H $30, $150, Due to brokers $100, Amounts payable to others secured Amounts payable to others unsecured $1, Bus. Phone: Restricted, control or margin account stocks Real estate owned see Schedule D Accounts, loans & notes receivable Automobiles Cash surrender value life insurance see Schedule E Vested interest in deferred compensation/ profitsharing plans See schedule F ventures see Schedule G Other assets/personal property itemize see Schedule G if applicable Accounts & bills due $225, Unpaid income tax Other unpaid taxes & interest Real estate mortgages payable $30, see Schedules D & H $74, $85, $50, $30, Total Liabilities Net Worth $ $105, , Total Assets $ 700, $ $ Total Liabilities and Net Worth $700, $ $ Section 4 Annual Income For Year End Annual Income (Individual) Annual Expenditures (Individual) Contingent Liabilities Estimated Amounts (Individual) Salary, bonuses & commissions Dividends & Interest Real estate income Other income (alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.) Total Income $14, Mortgage/rental payments $3, $5, Real estate taxes & assessments $2, $6, Taxesfederal, state & local $8, $19, Insurance payments Other contract payments (car payments, charge cards, etc.) $6, Alimony, child support, maintenance Other expenses $5, $ 44, $ Total Expenditures $ 26, $ Do you have any Contingent liabilities (as endorser, comaker or guarantor?) (On leases? On contracts? Involvement in pending legal actions? Contested income tax liens? Any estimated capital gains tax on the unrealized asset appreciation? Other special debt or circumstances? If "yes" to any question(s) describe: Total Contingent Liabilities $ $

3 SCHEDULE A CASH, CHECKING AND SAVINGS ACCOUNTS, CERTIFICATES OF DEPOSIT, MONEY MARKET FUNDS, ETC. Name of Financial Institution Type of Account Owner If Pledged, to Whom? Balance Reliance Bank Checking Jane Smith NA 10,000 PNC Savings Jane Smith NA 20,000 SCHEDULE B U.S.GOVERNMENT & MARKETABLE SECURITIES (use additional sheet if necessary) Number of Shares or Face Value of Bonds 1,500 shares Giant Public CO. Jane Smith Registered 150,000 NYSE Exchanges Where Traded SCHEDULE C NONMARKETABLE SECURITIES (Use additional sheet if necessary) Number of Shares 1,000 shares Dry Supply, Inc. Jane Smith Registered 100,000 Book Value Method of Valuation SCHEDULE D INVESTMENTS IN REAL ESTATE (Use additional sheet if necessary) /Location of Real Estate Investment Investment/Amount % Owned By You of Your % of Investment Present Balance Monthly Payment Mortgage Maturity Date Mortgage Owed To 1122 Blue Street, Altoona, PA 19x3 100% 150,000 24, Reliance Bank Florida Condo 19x9 100% 75,000 50, Bank of America SCHEDULE E LIFE INSURANCE CARRIED, INCLUDING GROUP INSURANCE Name of Insurance Company Owner of Policy Beneficiary and Relationship Face Amount Policy Loans Cash Surrender Value Prudential Jane Smith Joe SmithHusband $200,000 0 $85,000 SCHEDULE F VESTED INTEREST IN DEFERRED COMPENSATION/PROFITSHARING PLANS Manner of Payout % Vested Company Name Account Number (Annuity, Lump Sum, etc.) Prudential 401k Joe Smith Type: 401K, 403B,Pension, IRA Beneficiary Amount $50,000 SCHEDULE G BUSINESS VENTURES (Use additional sheet if necessary) List Name and Address of Any Your Position/Title in Venture In Which You Line of the Are a Principal or Partner Years in Total Assets Listed in Section 3 Your % of Ownership Net Worth of Present Net Value of Your Investment SCHEDULE H LOANS OWING BANKS, BROKERS, FINANCE COMPANIES, AND OTHERS (MASTERCARD, VISA, ETC.) Owing to (Acct..) Present Balance Due Monthly Payment Maturity Date Secured By Borrowing/Amount First Commonwealth Bank 40,000 20,000 1, Ford Fusion Chase 10, Credit CardRevolving The information contained in this statement is provided to induce you to extend or to continue the extension of credit to the undersigned or to others upon the guaranty of the undersigned. The undersigned acknowledges and understands that you are relying on the information provided herein in deciding to grant or continue credit or to accept a guaranty thereof. Each of the undersigned represents, warrants, and certifies that (1) the information provided herein is true, correct and complete and gives a correct and complete showing of the financial condition of the undersigned, (2) the undersigned has no liabilities direct, indirect or contingent except as set forth in this statement, and (3) legal and equitable title to all assets listed herein is in the undersigned's sole name, except as may be herein otherwise noted. Each of the undersigned agrees to notify you immediately and in writing of any change in name, address, or employment and of any material adverse change (1) in any of the information contained in this statement or (2) in the financial condition of any of the undersigned or (3) in the ability of any of the undersigned to perform its (or their) obligations to you. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein, and to determine the creditworthiness of the undersigned and the undersigned hereby authorizes all persons of whom you make such inquiries to respond thereto in full. Each of the undersigned authorizes you to answer questions about your credit experience with the undersigned. 10/1/2015 Signature Jane Smith Signature

4 PERSONAL FINANCIAL STATEMENT Submitted to: Date: If you are applying for individual credit in your own name and are relying on your own income, or assets and not the income or assets of another person as the basis for repayment of the credit requested, or if this statement relates to your guaranty of the indebtedness of other person(s), firm(s), or corporation(s), complete only Sections 1, 3, and 4. If you are applying for individual credit but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as a basis for repayment of the credit requested, complete all Sections. Provide information in Section 2 about the person whose alimony, support, or maintenance payments or income or assets you are relying on. Alimony, child support, or separate maintenance income, need not be revealed if you do not wish to have it considered as a basis for replaying this obligation. Section 1 Individual Information (type or print) Section 2 Other Party Information (type or print) Social Security #: Social Security #: Res. Phone: Bus. Phone: Res. Phone: Bus. Phone: Have (either of) you or any firm in which you were a major owner ever declared bankruptcy, or settled any debts for less than the amounts owed? If yes, please provide details on a separate sheet. Are (either of) you a defendant in any suit or legal action? Are (either of) you presently subject to any unsatisfied judgements to tax liens? When, if ever, have (either of) you been audited by IRS? Section 3 Statement of Financial Condition as of Assets (Do not include assets of doubtful value) Cash, Checking & Savings, CD's see Schedule A U.S. Gov't & marketable securities see Schedule B nmarketable securities see Schedule C Securities held by broker in margin accounts Liabilities tes payable to banks & others see Schedule H Due to brokers Amounts payable to others secured Amounts payable to others unsecured Restricted, control or margin account stocks Real estate owned see Schedule D Accounts, loans & notes receivable Automobiles Cash surrender value life insurance see Schedule E Vested interest in deferred compensation/ profitsharing plans See schedule F Accounts & bills due Unpaid income tax Other unpaid taxes & interest Real estate mortgages payable see Schedules D & H ventures see Schedule G Other assets/personal property itemize see Schedule G if applicable Total Liabilities Net Worth $ Total Assets $ $ $ Total Liabilities and Net Worth $ $ Section 4 Annual Income For Year End Annual Income (Individual) Annual Expenditures (Individual) Contingent Liabilities Estimated Amounts (Individual) Salary, bonuses & commissions Mortgage/rental payments Do you have any Contingent liabilities (as endorser, Dividends & Interest Real estate taxes & assessments comaker or guarantor?) Real estate income Taxesfederal, state & local (On leases? On contracts? Other income Involvement in pending legal Insurance payments actions? (alimony, child support, or Other contract payments separate maintenance income (car payments, charge cards, etc.) Contested income tax liens? need not be revealed if you do not Alimony, child support, Any estimated capital gains tax on wish to have it considered as a maintenance the unrealized asset appreciation? basis for repaying this obligation.) Other special debt or Other expenses circumstances? Total Income $ $ Total Expenditures $ If "yes" to any question(s) describe: Total Contingent Liabilities $ $

5 SCHEDULE A CASH, CHECKING AND SAVINGS ACCOUNTS, CERTIFICATES OF DEPOSIT, MONEY MARKET FUNDS, ETC. Name of Financial Institution Type of Account Owner If Pledged, to Whom? Balance SCHEDULE B U.S.GOVERNMENT & MARKETABLE SECURITIES (use additional sheet if necessary) Number of Shares or Face Value of Bonds Exchanges Where Traded SCHEDULE C NONMARKETABLE SECURITIES (Use additional sheet if necessary) Number of Shares Method of Valuation SCHEDULE D INVESTMENTS IN REAL ESTATE (Use additional sheet if necessary) /Location of Real Estate Investment Investment/Amount % Owned By You of Your % of Investment Present Balance Monthly Payment Mortgage Maturity Date Mortgage Owed To SCHEDULE E LIFE INSURANCE CARRIED, INCLUDING GROUP INSURANCE Name of Insurance Company Owner of Policy Beneficiary and Relationship Face Amount Policy Loans Cash Surrender Value SCHEDULE F VESTED INTEREST IN DEFERRED COMPENSATION/PROFITSHARING PLANS Manner of Payout % Vested Company Name Account Number (Annuity, Lump Sum, etc.) Type: 401k, 403B, Pension, IRA Beneficiary Amount SCHEDULE G BUSINESS VENTURES (Use additional sheet if necessary) List Name and Address of Any Your Position/Title in Venture In Which You Line of the Are a Principal or Partner Years in Total Assets Listed in Section 3 Your % of Ownership Net Worth of Present Net Value of Your Investment SCHEDULE H LOANS OWING BANKS, BROKERS, FINANCE COMPANIES, AND OTHERS (MASTERCARD, VISA, ETC.) Owing to (Acct..) Present Balance Due Monthly Payment Maturity Date Secured By Borrowing/Amount The information contained in this statement is provided to induce you to extend or to continue the extension of credit to the undersigned or to others upon the guaranty of the undersigned. The undersigned acknowledges and understands that you are relying on the information provided herein in deciding to grant or continue credit or to accept a guaranty thereof. Each of the undersigned represents, warrants, and certifies that (1) the information provided herein is true, correct and complete and gives a correct and complete showing of the financial condition of the undersigned, (2) the undersigned has no liabilities direct, indirect or contingent except as set forth in this statement, and (3) legal and equitable title to all assets listed herein is in the undersigned's sole name, except as may be herein otherwise noted. Each of the undersigned agrees to notify you immediately and in writing of any change in name, address, or employment and of any material adverse change (1) in any of the information contained in this statement or (2) in the financial condition of any of the undersigned or (3) in the ability of any of the undersigned to perform its (or their) obligations to you. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein, and to determine the creditworthiness of the undersigned and the undersigned hereby authorizes all persons of whom you make such inquiries to respond thereto in full. Each of the undersigned authorizes you to answer questions about your credit experience with the undersigned. Signature Signature