personal financial statement€¦ · personal balance sheet assets social security no. name...
TRANSCRIPT
As of:
YEARS
YEARS
YEARS
YEARS
Schedule 1
Schedule 2
Schedule 3
Schedule 4
Schedule 5
Income Tax
Other Taxes
ESTIMATED CREDIT CARD BALANCES
OTHER LIABILITIES:
OTHER NOTES PAYABLE
PERSONAL PROPERTY & AUTOMOBILES:
ACCOUNTS PAYABLEREAL
ESTATE
Homestead
OTHER ASSETS:
Total Assets
Total Liabilities
Net Worth (Assets - Liabilities)
Total Liabilities and Net Worth
Total Contingent Liabilities
Homestead
Other Wholly-Owned R/E
Partially Owned R/E
REAL
ESTATE
Schedule 7
DRIVER'S LICENSE ST & NO.
PLEASE COMPLETE THE ACCOMPANYING SCHEDULES TO THIS PERSONAL FINANCIAL STATEMENT
Agreement: Each of the undersigned certifies that the information provided in this Personal Financial Statement is true and correct as of the date set forth opposite the signature and that any intentional
or negligent misrepresentation of information provided may result in civil liability and/or criminal penalties under Title 18 of the United States Code. Each of the undersigned authorizes Vantage Bank
Texas (“the Bank”) to check their credit and employment history and to answer any questions about the Bank’s credit experience with them. Each of the undersigned also agrees to notify Vantage Bank
Texas of any material adverse change in financial condition and to furnish current financial information if requested by the Bank.
PHONE
NAME DATE OF BIRTH
SOCIAL SECURITY NO.
If you are applying for individual credit in your name and are relying on your own income or assets and not the income or assets of another person as the basis for loan qualification, please include
information for yourself only. If the income or assets of a person other than you (to include your spouse) will also be used as a basis for loan qualification, please include information for that person.
OCCUPATION
BUSINESS ADDRESS & PHONE NO.
HOME ADDRESS WITH ZIP CODE
PERSONAL BALANCE SHEET
Assets
SOCIAL SECURITY NO.
NAME
Liabilities
NO. OF DEPENDENTS
DATE OF BIRTH
BORROWER OR GUARANTOR
HOME ADDRESS WITH ZIP CODE
OCCUPATION
EMPLOYER
BUSINESS ADDRESS & PHONE NO.NAME OF INDIVIDUAL WITH JOINT INCOME/ASSETS NO. OF DEPENDENTS
CO-BORROWER OR OTHER GUARANTOR (if joint credit)
NAME OF INDIVIDUAL WITH JOINT INCOME/ASSETS
DRIVER'S LICENSE ST & NO.
EMPLOYER
PHONE
STOCKS, BONDS, & SECURITIES
Schedule 8
CASH
Schedule 7
NON-REAL ESTATE PARTNERSHIPS
Schedule 6
Other Wholly-Owned R/E
Partially Owned R/E
TAXES OWING
Personal Financial Statement
ACCOUNTS, LOANS, & NOTES RECEIVABLE
CASH SURRENDER VALUE LIFE INSURANCE
DEFERRED COMPENSATION AND RETIREMENT
PLANS
45 NE Loop 410 Ste. 500 San Antonio, Texas 78216 210.408.5700
DateSignature Signature Date
Print Name Print Name
Page 1 of 4
Vantage Bank Texas | Personal Financial Statement
PLEDGED
Yes/No
SHARES COSTPLEDGED
Yes/No
SCHEDULE 3
% OWNED COSTPLEDGED
Yes/No
SCHEDULE 4ORIGINAL
AMOUNT
PRESENT
BALANCERATE
MONTHLY
PAYMENTSMATURITY
CURRENT
Yes/No
SCHEDULE 5
PLEDGED
Yes/No
SCHEDULE 6NET PLAN VALUE/ VESTED
INTEREST
BANKING RELATIONSHIPS - DEPOSITORY ACCOUNTS
TOTAL NET PLAN VALUE
COLLATERAL
BENEFICIARY
* INCLUDES I.R.A. ACCOUNTS, KEOGH, 401(K), FULLY VESTED BENEFIT PLANS, ETC.
TRUSTEE OR PLAN
ADMINISTRATOR
TOTAL CASH VALUE
CASH VALUE
TYPE OF ACCOUNT
SCHEDULE 2
FACE VALUE
TOTAL PRESENT BALANCE
REGISTERED IN THE NAME OF
PARTNER NAME
DUE FROM
TYPE OF ACCOUNT
MARKET VALUE
ACCOUNT NUMBER
COMPANY
MARKET PER SHARE
TOTAL PARTNERSHIPS
INSURED
ACCOUNTS, LOANS, & NOTES RECEIVABLE
BENEFICIARY
EQUITY (NET OF DEBT) PARTNER EQUITY
TOTAL CASH
NAME OF SECURITY
NON-REAL ESTATE PARTNERSHIPS
STOCKS, BONDS, & SECURITIES
NAME OF PARTNERSHIP
BANK NAME & LOCATIONNAME(S) ON ACCOUNT CASH BALANCE
TOTAL STOCKS, BONDS, & SECURITIES
LIFE INSURANCE AND ANNUITIES (Including Employer Provided)
DEFERRED COMPENSATION & RETIREMENT PLANS*
SCHEDULE 1
BALANCEREGISTERED IN THE NAME
OF
Page 2 of 4
Vantage Bank Texas | Personal Financial Statement
SCHEDULE 7
LIENHOLDERDATE
PURCHASED
MARKET
VALUE
MORTGAGE
BALANCE
ORIGINAL
AMOUNT
INTEREST
RATE
MONTHLY
PAYMENTS
DATE OF
MATURITY
SCHEDULE 8
ORIGINAL
AMOUNT
PRESENT
BALANCERATE
MONTHLY
PAYMENTSMATURITY
CURRENT
Yes/No
SCHEDULE 9
ORIGINAL
AMOUNT
PRESENT
BALANCE
MONTHLY
PAYMENTSMATURITY
COLLATERAL
VALUE
COLLATERAL
*IF EXTRA LINES ARE REQUIRED, PLEASE ATTACH AN
ADDITIONAL SCHEDULE
COLLATERAL
BORROWER
TOTAL CONTINGENT LIABILITIES
PAYEE
PARTIALLY OWNED R/E
TOTAL OTHER NOTES PAYABLE
HOMESTEAD
OTHER WHOLLY-OWNED R/E
LIENHOLDER
OTHER NOTES PAYABLE (Non-Real Estate)
REAL ESTATE
CONTINGENT LIABILITIES (Are you a Co-maker, Endorser, Obligor, or Guarantor on any loans?)
*PROPERTY DESCRIPTION & ADDRESS
PARTIALLY OWNED R/E
OTHER WHOLLY OWNED R/E
PROPERTY OWNER &
% OWNED
HOMESTEAD
TOTALS
Page 3 of 4
Vantage Bank Texas | Personal Financial Statement
Current YearNext Year
(Estimate)Current Year
Next Year
(Estimate)
Insert Date Insert Date Insert Date Insert Date
Other: Other:
Other:
Other:
Y/N
Y/N
Y/N
Y/N
Year Ended
Y/N
Y/N
Y/N
ADDITIONAL REMARKS
Tax Refund
Rental Income
SOURCES OF CASH
Sale of Assets
Salaries & Wages
ADDITIONAL INFORMATION
1. Do you have a will?
If "Yes", describe below:
If "Yes", describe below:
If "Yes", Name of Executor:
2. Are you a partner or officer in any other venture(s)?
Other Business Expenses
Commission, Bonus, Etc. Other Payroll Ded.
Other Business Income
Distributions
Income Taxes
Living Expenses & Misc.
3. Are you obligated to pay alimony, child support, or separate maintenance
payments?
4. Are any assets pledged other than as described on the schedules?
8. Have you been declared bankruptcy in the past 10 years?
If "Yes", describe below:
Subtotal
Rental Expenses
DEB
T SE
RV
ICE
Other Principal PaymentsDistributions
Total Cash Uses
NO
N-R
ECU
RR
ING
Interest & Dividends
Mortgage Payments
Subtotal
Commission, Bonus, Etc.
PERSONAL CASH FLOW STATEMENT
EXP
ENSE
S
USES OF CASH
5. Income Tax settled through:
If "Yes", describe below:
Net Cash Flow (Sources - Uses)
If "Yes", describe below:
REC
UR
RIN
G
Total Cash Sources
Insurance Premiums
PERSONAL INFORMATION
Loan Payments
6. Are you a party to any suits or legal actions?
7. Are there any unsatisfied judgments against you?
If "Yes", describe below:
Page 4 of 4
Vantage Bank Texas | Personal Financial Statement
Additional Real Estate Schedule
LIENHOLDERDATE
PURCHASED
MARKET
VALUE
MORTGAGE
BALANCE
ORIGINAL
AMOUNT
INTEREST
RATE
MONTHLY
PAYMENTS
DATE OF
MATURITY
*PROPERTY DESCRIPTION & ADDRESSPROPERTY OWNER &
% OWNED
OTHER WHOLLY OWNED R/E
ADDITIONAL INFORMATION
PARTIALLY OWNED R/E
PARTIALLY OWNED R/ETOTALS
OTHER WHOLLY-OWNED R/E
1