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. Date Picker Icon

Assets (Do not include assets of doubtful value.)

	In Dollars (Omit Cents)	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)	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 Date Picker Icon

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 Date Picker Icon

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 Date Picker Icon

SSN

Signature (Other Party)

Clear

Date of Birth

Date Date Picker Icon

SSN

Date Signed

Date Date Picker Icon

Personal Financial Statement

Section 1: Individual Information

Section 2: Other Party Information

Section 3: Statement Of Financial Information

Personal Information