Form PS-15 at a glance
What it is: Personal Financial Statement TO the Lender (Name of Lender).
Who signs: Enter the Date Signed and sign on Signature; the Other Person signs on the second Signature if Applicable.
A filled-in Form PS-15 example: an individual lists one checking account
How to fill out Form PS-15, box by box
Type of credit
Check the appropriate box for the type of credit: Individual, to provide Financial Information only about yourself, or Joint, with Relationship, to provide Financial Information about yourself and the other person.
Name, Birth Date and Address
Enter your Name, Birth Date, Statement Date, Address, City, State/Zip, Social Sec. No., Home Phone, No. of Dependents, Bus. or Occupation and Bus. Phone.
Cash in banks and notes due to banks
In A CASH IN BANKS AND NOTES DUE TO BANKS, enter the NAME OF BANK, Type of Account, On Deposit, Notes Due Banks, Type of Ownership and COLLATERAL (If Any) & Type of Ownership, and List all Real Estate Loans in Section II-E.
Under TOTALS, Enter Sec. 1 Line 21 and Enter Sec. 1 Line 1.
More rules for Form PS-15
Any willful misrepresentation could result in a violation of Federal Law (Sec. 18 U.S.C. 1014).
Complete all of Section II BEFORE Section I.
Under GENERAL INFORMATION, mark No or Yes: Are any Assets Pledged? (See Section II); Are you a Defendant in any Suits or Legal Actions? (Explain); Have you ever been declared Bankrupt in the last 10 years? (Explain).
Provide the following information only if Joint Credit is checked: Other Persons Salary, Bonuses & Commissions and Other income of Other Person - Itemize.
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.
Under CONTINGENT LIABILITIES, enter As Endorser, Co-maker or Guarantor, On Leases or Contracts, Legal Claims, Federal - State Income Taxes and Other -.
Net Worth is Total Assets minus Total Liabilities.
In SECTION II B LIFE INSURANCE, List only those Policies that you own.
In C SECURITIES OWNED, include U.S. Gov't Bonds and all other Stocks and Bonds.
In D NOTES AND ACCOUNTS RECEIVABLE, list Money Payable or Owed to You Individually-Indicate by a if Others have an Ownership Interest.
In H NOTES, list those Other than Bank, Mortgage and Insurance Company Loans, ACCOUNTS AND BILLS AND CONTRACTS PAYABLE.
Each individual signing authorizes the Lender to check their individual credit account and employment history and have a credit reporting agency prepare a consumer credit report on them.
The undersigned also agrees to notify the Lender immediately in writing of any significant adverse change in such financial condition.
Common questions about Form PS-15
Who signs it?
Enter the Date Signed and sign on Signature; the Other Person signs on the second Signature if Applicable.
What am I certifying when I sign?
For the purpose of procuring credit from time to time, you furnish this statement as a true and accurate statement of your financial condition, and Authorization is hereby given to the Lender to verify in any manner it deems appropriate any and all items indicated on this statement.
Sources
[1] Form PS-15 (2/26/2001), Personal Financial Statement, Wolters Kluwer Financial Services - Bankers Systems (the Official source link on this page).