First National Bank Statement Form PDF Details

The First National Bank Statement Form serves as a comprehensive document designed to capture the full spectrum of an individual's or a co-applicant's financial status for the purpose of securing and maintaining credit. Its significance lies in its meticulous compilation of personal and financial information, which includes but is not limited to, personal data (such as full name, Social Security Number, address, and marital status), detailed listings of assets and liabilities, and schedules that break down specific categories like cash holdings, securities, life insurance, real estate, retirement accounts, and personal property. Individuals are urged not to transmit this sensitive document via unencrypted email, emphasizing the importance of confidentiality in financial dealings. This form acts not just as a snapshot of one's current financial condition but also as a dynamic record that requires updating in the event of any material changes to one's financial health. By accurately filling out this form, individuals pledge the truthfulness of the provided information, which the bank reserves the right to verify through any means it finds necessary. The exhaustive nature of this document showcases the bank's diligence in assessing the financial reliability of applicants, underscoring the significance of full disclosure for both parties involved in the credit process.

QuestionAnswer
Form NameFirst National Bank Statement Form
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesbank statement fnb, sample crdb bank statement, fnb bank statement sample, financial statement unanswered

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PERSONAL FINANCIAL STATEMENT

FOR SECURITY PURPOSES, DO NOT RETURN THE COMPLETED STATEMENT VIA UNENCRYPTED E-MAIL

CONFIDENTIAL - PLEASE DO NOT LEAVE ANY QUESTIONS UNANSWERED

For the purpose of procuring and maintaining credit from time to time in any form whatsoever with the above named Bank, for claims and demands against the undersigned, the undersigned submits the following as being a true and accurate statement of his/her financial condition on the following date, and agree that if any change occurs that materially reduces the means or ability of the undersigned to pay all claims or demands against him/her, the undersigned will immediately and without delay notify the said Bank, and unless the Bank is so notified it may continue to rely upon the statement herein given as a true and accurate statement of the financial condition of the undersigned.

 

 

 

 

 

Statement of financial condition as of:

 

 

 

 

 

 

 

 

 

 

 

 

 

INDIVIDUAL 1

 

 

INDIVIDUAL 2

 

 

 

 

 

 

 

 

 

 

 

Full Name

 

SSN

 

Full Name

 

 

SSN

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State, Zip

 

 

 

 

City, State, Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

Since

 

Rented

Owned

Since

 

 

Rented

Owned

 

 

 

 

 

 

 

 

 

 

Previous Address if < 5 years

 

 

 

 

Previous Address if < 5 years

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State, Zip

 

 

 

 

City, State, Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

Since

 

Rented

Owned

Since

 

 

Rented

Owned

 

 

 

 

 

 

 

Date of Birth

 

Dependents Excluding Self

 

Date of Birth

Dependents Excluding Self

 

Residence Phone

 

Work Phone

 

Residence Phone

 

 

Work Phone

 

 

 

 

 

 

 

 

 

 

E-Mail Address

 

Cell Phone

 

E-Mail Address

 

 

Cell Phone

 

 

 

 

 

 

 

 

 

 

Employer

 

Since

 

Employer

 

 

Since

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position / Title

 

 

 

 

Position / Title

 

 

 

 

 

 

 

 

 

 

 

 

Marital Status* :

Unmarried

Married

Separated

Marital Status* :

Unmarried

Married

Separated

 

 

 

 

 

 

 

* Do not provide this information if this form is being submitted in conjunction with an application for individual, unsecured credit.

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE COMPLETE ATTACHED SCHEDULES 1-14

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ASSETS

 

 

LIABILITIES

 

 

 

 

 

 

 

 

 

 

Cash Schedule ( Schedule 1 )

 

 

 

 

Loans & Notes Due to Financial Institutions ( Schedule 9 )

 

 

 

 

 

 

 

 

 

 

Securities ( Schedule 2 )

 

 

 

 

Loans & Notes Due to Others ( Schedule 10 )

 

 

Life Insurance Cash Value ( Schedule 3 )

 

 

 

Credit Cards & Other Revolving Accounts ( Schedule 11 )

 

 

 

 

 

 

 

Mortgages and Contracts Held by You ( Schedule 4 )

 

 

Other Debts - Lease Payments, Unpaid Taxes, Etc. ( Schedule 12 )

 

 

 

 

 

 

 

 

 

Closely Held Business Investments ( Schedule 5 )

 

 

Insurance Loans ( Schedule 3 )

 

 

 

 

 

 

 

 

 

 

 

Primary Residence ( Schedule 6 )

 

 

 

Mortgages on Primary Residence ( Schedule 6 )

 

 

 

 

 

 

 

 

 

 

Other Real Estate ( Schedule 7 )

 

 

 

 

Mortgages on Other Real Estate ( Schedule 7 )

 

 

 

 

 

 

 

 

Profit Sharing, Pension, IRA & Other Retirement ( Schedule 8 )

 

 

Profit Sharing, Pension and IRA Loans ( Schedule 8 )

 

 

 

 

 

 

 

 

 

 

 

 

Vehicles ( Schedule 13 )

 

 

 

 

Other Liabilities ( Schedule 13 )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Personal Property

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Assets ( Schedule 13 )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL Assets $

 

 

 

TOTAL Liabilities $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net Worth $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANNUAL INCOME

 

 

 

 

Applicant

Co-Applicant

Salary

Commissions

Dividends

Interest

Rentals

Alimony, Child support or Maintenance - need not be revealed if you do not wish to have it considered as a basis for repaying this obligation

Other

TOTAL INCOME

VERSION 12/5/11

Page 1 of 4

FOR SECURITY PURPOSES, DO NOT RETURN THE COMPLETED STATEMENT VIA UNENCRYPTED E-MAIL

Schedule 1 / Cash, Savings, & Certificates of Deposit

Name of Bank or Financial Institution

How Owned JT, IND, Trust

Type of Account

Account Balance

TOTAL $

Schedule 2 / Securities Owned or Attach Brokerage Statements

No. of Shares

Description

Registered in Name(s) of

Listed / Unlisted

Current Market Value

TOTAL $

Schedule 3 / Life Insurance

Insurance Company

Insured

Beneficiary

Face Value of Policy Cash Value of Policy

Loans

TOTALS $

Schedule 4 / Receivables Due To Me on Mortgages and Contracts I Own

Name of Debtor

Description of Property

1st or 2nd Lien

Date of Maturity

Repayment Terms

Balance Due

TOTAL $

Schedule 5 / Closely Held Business Investments (attach additional schedule if necessary)

Company Name

Description of Business / Investment

Ownership (%)

Source of Value

Value

Attached Schedule

TOTAL $

Schedule 6 / Primary Residence

Year Acquired

Address

Name of Creditor

Purchase Price

Mortgage Balance

Maturity Date

How Owned

JT, IND, Trust

Repayment Terms

Current Market

Value

Insurance Company

 

Agent

 

Phone

 

 

 

 

 

VERSION 12/5/11

Page 2 of 4

FOR SECURITY PURPOSES, DO NOT RETURN THE COMPLETED STATEMENT VIA UNENCRYPTED E-MAIL

Schedule 7 / Other Real Estate Owned (attach additional schedule if necessary)

Property Type

Address

Year

Acquired

Name of Creditor

Purchase Price

Mortgage Balance

Maturity Date

How Owned

JT, IND, Trust

Repayment Terms

Current Market

Value

Attached Schedule

TOTAL $

Schedule 8 / Profit Sharing, Pension, IRA Accounts & Other Retirement Accounts

Attached Schedule

TOTAL $

Name of Institution

Type of Account

Account Balance

Vested Balance

Loans

TOTALS $

Schedule 9 / Loans & Notes Due to Financial Institutions

Name of Creditor

Collateral

Maturity Date

Repayment Terms

Balance Due

TOTAL $

Schedule 10 / Loans & Notes Due to Others

Name of Creditor

Collateral

Maturity Date

Repayment Terms

Balance Due

TOTAL $

Schedule 11 / Credit Cards & Other Revolving Accounts

Name of Creditor

Collateral

Maturity Date

Repayment Terms

Balance Due

TOTAL $

VERSION 12/5/11

Page 3 of 4

FOR SECURITY PURPOSES, DO NOT RETURN THE COMPLETED STATEMENT VIA UNENCRYPTED E-MAIL

Schedule 12 / Other Debts - Lease Payments, Unpaid Taxes, Etc.

Description

Repayment Terms

Balance Due

TOTAL $

Schedule 13 / Vehicles, Other Assets, and Other Liabilities

Vehicles (Describe)

Value

Other Assets (describe)

Value

Other Liabilities (describe)

Balance

 

TOTAL $

 

 

TOTAL $

 

TOTAL $

 

 

 

 

 

 

Schedule 14 / Contingent Liabilities - Endorser, Grantor, Lawsuits, For Taxes, Other (attach additional schedule if necessary)

 

 

 

 

 

 

 

 

 

Contingent Liabilities

( Describe )

 

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attached Schedule

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL $

 

 

 

 

 

 

 

 

Name of Accountant

 

Attorney

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

In the last 7 years, have you had any unsatisfied judgments or declared bankruptcy ?………………………………………………………………

 

In the last 7 years, have you had property foreclosed upon or given title or deed in lieu thereof ?………………………………………………….

 

Do you have any unused credit facilities at any other institutions ?…………….………………………………………………………………………..

 

 

 

 

 

Year

 

Have you prepared a will and / or estate plan ?

What Year ?………………………..……………………………………

 

 

 

 

 

 

 

 

 

You certify that the information provided in this statement is true and correct. So long as you owe any sums to the bank, you agree to give the bank prompt written notice of any material change in your financial condition and upon request, you agree to provide the bank with an updated personal financial statement. The bank is authorized to retain this personal financial statement whether or not credit is approved and is further authorized to verify by whatever means it deems necessary your credit and employment history or any other information in this statement. The submission of this form does not obligate the bank to make any loan even if you meet the normal standards the bank considers in determining whether to approve or deny an extension of credit.

Individual 1 Signature

Date

Individual 2 Signature

Date

VERSION 12/5/11

Page 4 of 4

 

 

Statement of financial condition as of:

 

 

 

 

 

 

 

INDIVIDUAL 1

 

INDIVIDUAL 2

 

 

 

 

 

Full Name

SSN

Full Name

SSN

 

 

 

 

 

Schedule 5 / Closely Held Business Investments (continuation from main schedule)

Company Name

Description of Business / Investment

Ownership (%)

Source of Value

Value

SUBTOTAL $

Schedule 7 / Other Real Estate Owned (continuation from main schedule)

Property Type

Address

Year

Acquired

Name of Creditor

Purchase Price

Mortgage Balance

Maturity Date

How Owned JT, IND, Trust

Repayment Terms

Current Market

Value

 

SUBTOTAL $

 

SUBTOTAL $

 

 

 

 

Schedule 14 / Contingent Liabilities - Endorser, Grantor, Lawsuits, For Taxes, Other (continuation from main schedule)

Contingent Liabilities ( Describe )

Amount

SUBTOTAL $

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Completing section 1 in national bank personal financial statement

2. When this section is completed, go to enter the relevant details in all these: ASSETS, LIABILITIES, Cash Schedule Schedule, Securities Schedule, Loans Notes Due to Financial, Loans Notes Due to Others, Life Insurance Cash Value, Credit Cards Other Revolving, Mortgages and Contracts Held by, Other Debts Lease Payments Unpaid, Closely Held Business Investments, Insurance Loans Schedule, Primary Residence Schedule, Other Real Estate Schedule, and Mortgages on Primary Residence.

Step no. 2 for filling out national bank personal financial statement

3. Throughout this part, examine Interest, Rentals, Alimony Child support or, Other, TOTAL INCOME, Version, and Page of. Every one of these should be filled out with greatest accuracy.

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