Personal Financial Statement

If you are applying for individual credit in your own name and are relying on your own income or another person as the basis for repayment of the credit requested, complete only Sections 1 and 3.

If you are applying for joint credit with another person, complete ALL sections providing information in Section 2 about the joint application

If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance of on the income or assets of another person as a basis for repayment of the credit requested, complete ALL sections, providing information in Section 2 about the person whose alimony, support or maintenance payments or income or assets you are relying on.

If this statement relates to your guaranty of the indebtedness of other person(s), firm(s), or corporation(s), complete Sections 1 and 3.

Name

First Name Last Name

Residence Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Position/Occupation

Business Name

Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Residence Phone

Area Code Phone Number

Business Phone

Area Code Phone Number

Name

First Name Last Name

Residence Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Position/Occupation

Business Name

Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Residence Phone

Area Code Phone Number

Business Phone

Area Code Phone Number

Today's Date

Statement of financial information as of date stated here.

Assets (Do not include assets of doubtful value.)

In Dollars (Omit Cents)

Cash on hand and in banks

U.S. Gov’t & Marketable Securities – see Schedule A

Non-marketable Securities – see Schedule B

Securities held by broker in margin accounts

Restricted or control stocks

Real Estate owned as personal residence
See Schedule C

Real Estate owned for investment purposes
See Schedule D (attached)

Loans receivable

Automobiles and other personal property

Cash value life insurance – see Schedule E

Other assets – itemize

Total Assets

Liabilities

In Dollars (Omit Cents)

Notes payable to banks – secured

Notes payable to banks – unsecured

Due to brokers

Amounts payable to others – secured

Amounts payable to others - unsecured

Accounts and bills due

Unpaid income taxes and interest

Real estate owned as personal residence
Mortgages payable – see Schedule C

Real estate owned for investment purposes mortgages payable – see Schedule D

Credit card/revolving debt

Other debts – total

If Any- Other Debts Itemized here

Total Liabilities

Net Worth

NET WORTH= ASSETS - LIABILITIES

Total Liabilites & Net Worth

Sources Of Income For Year Ended

Date

Sources Of Income Listed Here

In Dollars (Omit Cents)

Salary, bonuses & commissions

Dividends

Net 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

Do you Have Any Contingent Liabilities? If So, Describe Here

Contingent Liabilities

In Dollars (Omit Cents)

As endorser, co-maker or guarantor

On leases or contracts

Legal claims

Other special debt

Amount of contested income tax liens

Do You Have A Will?

Yes No

If Yes, Name Of Executor

Are you a partner or officer in any other venture? If so describe.

Are you obligated to pay alimony child support or separate? If so, describe

Are any assets pledged other than as described on schedules? If so, describe

Income tax settled through (date)

Date

Are you a defendant in any suits or legal actions?

Personal bank accounts carried at

Have you ever been declared bankrupt? If so, describe

SCHEDULE A – U.S. GOVERNMENTS AND MARKETABLE SECURITIES

Number of Shares
of Face Value (Bonds)

Description

In Name Of

Are These
Pledged?

Market Value

1

2

3

4

5

SCHEDULE B – NON-MARKETABLE SECURITIES

Number of Shares
of Face Value (Bonds)

Description

In Name Of

Are These
Pledged?

Source of
Value

Value

1

2

3

4

5

SCHEDULE C – REAL ESTATE OWNED: A PERSONAL RESIDENCE

Address & Type Of Property

Title In Name
Of

% Of
Ownership

Date
Acquired

Cost

Market Value

Rental Income

Mortgage Amount

1

2

3

4

5

SCHEDULE D – REAL ESTATE OWNED FOR INVESTMENT PURPOSES

Address & Type Of Property

Title In Name
Of

% Of
Ownership

Date
Acquired

Cost

Market Value

Rental Income

Mortgage Amount

1

2

3

4

5

SCHEDULE E – LIFE INSURANCE CARRIED, INCLUDING N.S.L.I. AND GROUP INSURANCE

Name of
Insurance Company

Owner of Policy

Beneficiary

Face Amount

Policy Loans

Cash Surrender Value

1

2

3

4

5

SCHEDULE F – BANKS OR FINANCE COMPANIES WHERE CREDIT HAS BEEN OBTAINED

Name & Address of
Lender

Credit In The Name Of

Secured Or Unsecured

Original Date

High Credit

Current Balance

1

2

3

4

5

The information contained in this statement is provided for the purpose of obtaining or maintaining credit with MCG on behalf of the undersigned
or persons, firms or corporations in whose behalf the undersigned may either severally or jointly with others, execute a guaranty in MCG’s favor.
Each undersigned understands that MCG is relying on the information provided herein (including the designation made as to ownership of
property) in deciding to grant or continue credit. Each undersigned represents and warrants that the information provided is true and complete
and that MCG may consider this statement as continuing to be true and correct until a written notice of a change is given to MCG by the
undersigned. MCG is authorized to make all inquiries deemed necessary to verify the accuracy of the statements made herein, and to determine
my/our creditworthiness. MCG is authorized to answer questions about its credit experience with me/us

Signature (Individual)

Clear

Date of Birth

Date

SSN

Signature (Other Party)

Clear

Date of Birth

Date

SSN

Personal Financial Statement

Section 1: Individual Information

Section 2: Other Party Information

Section 3: Statement Of Financial Information

Personal Information