navyfederal.

org
Personal Financial Statement 1-877-418-1462
Important: Please read and check off one of the following statements. (If applying for joint credit, both parties must also initial in the appropriate area.)
□ This personal financial statement is being offered in conjunction with an individual application for consumer/business purpose credit, for an extension or
renewal of such credit, or compliance with annual financial reporting requirements. (Complete sections 1, 3, and 4.)
□ This personal financial statement is being offered in conjunction with a joint application for consumer/business purpose credit, for an extension or renewal
of such credit, or compliance with annual financial reporting requirements. (Complete all sections on this page and initial below.)

Section 1—Individual Information

Name: First MI Last Suffix

Address: Street City State Zip Code

Business Name Position or Occupation

Business Address: Street City State Zip Code Length of Employment

Contact Phone No. Business Phone No. □ U.S. Citizen □ Permanent Resident Applicant Initials
□ Other _____________________________ 4
Section 2—Other Party Information
Name: First MI Last Suffix

Address: Street City State Zip Code

Business Name Position or Occupation

Business Address: Street City State Zip Code Length of Employment

Contact Phone No. Business Phone No. □ U.S. Citizen □ Permanent Resident Co-applicant Initials
□ Other _____________________________ 4
Section 3—Statement of Financial Condition as of: 20___
Assets In dollars Liabilities In dollars
(Do not include assets of doubtful value) (Omit cents) (Omit cents)

Cash on hand and in financial institutions Notes payable to banks (See Schedule F)
Cash in other banks
Notes payable to other institutions (See Schedule F)
(Bank Certificates of Deposit—See Schedule A)
U.S. Gov’t and marketable securities (See Schedule B) Due to brokers

Non-marketable securities (See Schedule C) Amounts payable to others

IRA/401(k)/Retirement accounts Student loans

Restricted, control, or margin account stocks Accounts and bills due

Real estate owned (See Schedule D) Unpaid income tax (Tax year _________ )

Accounts, loans, and notes receivable Other unpaid taxes and interest

Automobiles Real estate mortgages payable (See Schedule D)

Other personal property Other debts (car payments, credit cards, etc.) - itemize

Cash surrender value - life insurance (See Schedule E)

Other assets - itemize (See Schedule G if applicable)

Total Liabilities

Total Net Worth (Total Assets Minus Total Liabilities)

Total Assets Total Liabilities and Net Worth

© 2013 Navy Federal
NFCU 566B (2-13) CONFIDENTIAL Page 1 of 3
e
Personal Information
Do you have a will? □ Yes □ No

Have you ever declared bankruptcy? □ Yes □ No If so, describe: ____________________________________________________________________________

_____________________________________________________________________________________________________________________________________

Have you ever been audited by the IRS? □ Yes □ No If so, describe: ________________________________________________________________________
_____________________________________________________________________________________________________________________________________

Section 4—Annual Income

For Year Ended: 20_____ Annual Expenditures Contingent Liabilities Estimated Amounts

Salary Mortgage/Rental Payments Contingent Liabilities □ Yes □ No

Other special debt
Bonus/Commissions Real Estate Taxes and Assessments □ Yes □ No
or circumstances
Contested
Dividends/Interest Taxes–Federal, state, and local □ Yes □ No
Income Tax Liens
If yes to any, please describe:
Real Estate Income Insurance Payments

Tax-Free Income Other Contract Payments

(Car payments, charge cards, etc.)
Alimony/Child Support/
Other Income Maintenance
Total Income Other Expenses

Total Expenditures Total Contingent Liabilities

Schedule A—Cash and Certificate of Deposit in Other Financial Institutions

Are these pledged or
Description Name of Institution In the Name of: Value
held by others?

□ Yes □ No

□ Yes □ No

□ Yes □ No

Schedule B—U.S. Government and Marketable Securities

No. of Shares/ Are these pledged or
Description In the Name of: Cost Market Value
Face Value of Bonds held by others?

□ Yes □ No

□ Yes □ No

□ Yes □ No

Schedule C—Non-Marketable Securities

Are these pledged or
No. of Shares Description In the Name of: Original Investment Source of Value Current Value
held by others?

□ Yes □ No

□ Yes □ No

□ Yes □ No

CONFIDENTIAL Page 2 of 3
Schedule D—Residence and Other Real Estate (Partially or Wholly Owned)
% of Monthly Mortgage Mortgage
Address and Property Type Title in Name of: Date Acquired Cost Market Value
Ownership Payment Maturity Balance

Schedule E—Life Insurance Carried (Including Group Insurance)

Name of Insurance Company Owner of Policy Beneficiary and Relationship Face Amount Policy Loans Cash Surrender Value

Schedule F—Bank and Other Institutional Relationships

Original Loan/ Unsecured or Secured
Name and Address of Creditor Date of Loan Maturity Date Monthly Payment Amount Owed
Line Amount (List Collateral)

Schedule G—Business Ventures and Other Assets

List name and address of any business Total Assets % of Your Position/Title in the Years in Total Assets
venture in which you are the owner, Line of Business
Listed in Section 3 Ownership Business Business in the Business
stockholder, or partner

The information contained in this statement is provided to induce adverse change (1) in any of the information contained in this statement;
Navy Federal Credit Union (“NFCU”) to extend or continue the extension of (2) in the financial condition of any of the undersigned; or (3) in the ability
credit to the undersigned or to others upon the surety of the undersigned. of any of the undersigned to perform its (or their) obligations to NFCU.
The undersigned acknowledge and understand that NFCU relies on the In the absence of such notice or a new and full written statement, this
information provided herein in deciding to grant or continue credit or accept should be considered as a continuing statement and substantially correct.
a surety thereof. Each of the undersigned represents, warrants, and NFCU is authorized to make all inquiries it deems necessary to verify
certifies that the information provided herein is true, correct, and complete. the accuracy of the information contained herein, and to determine the
Each of the undersigned agrees to notify NFCU immediately and in writing creditworthiness of the undersigned. Each of the undersigned authorizes
of any change in name, address, or employment and of any material NFCU to answer questions about its experience with the undersigned.

Applicant’s Signature
4
Social Security No. (SSN) Date of Birth (Mo., Day, Yr.) Date Signed (Mo., Day, Yr.)

Co-applicant’s Signature
4
Social Security No. (SSN) Date of Birth (Mo., Day, Yr.) Date Signed (Mo., Day, Yr.)

CONFIDENTIAL Page 3 of 3