Personal Financial Statement | Sab Tera Lending

Statement Date

Personal Financial Statement As Of

Personal Information

Complete information below in accordance with the credit request. If the request is in a single name, do not include 100% of joint assets.

Applicant *

Name *

Home Address

Date of Birth

Social Security No.

Home Phone No.

Cell Phone No.

Email Address *

Employer

Address of Employer

City, State, Zip

Title / Position / Years

Accountant (name, phone)

Attorney (name, phone)

Insurance Agent (name, phone)

Co-Applicant (optional)

Name

Home Address

Date of Birth

Social Security No.

Home Phone No.

Cell Phone No.

Email Address

Employer

Address of Employer

City, State, Zip

Title / Position / Years

Accountant (name, phone)

Attorney (name, phone)

Insurance Agent (name, phone)

Assets

Do not include assets of doubtful value. In dollars (omit cents).

Cash in this Bank (Schedule F)
Cash in Other Financial Institutions (Sch. F)
U.S. Gov't & Marketable Securities (Sch. A)
Non-Marketable Securities (Schedule A)
IRA, Profit Sharing & Other Vested Ret. Accts.
Cash Value - Life Insurance (Schedule B)
Accounts & Notes Receivable
Real Estate Investments (Schedule C)
Residential Real Estate (Schedule C)
Prtnrshp/PC/LLC/S Corp Interests (Sch. C)
Non-Real Estate Business Ventures (Sch. D)
Personal Property (including automobiles)
Other Assets (itemize)

Liabilities

Notes Payable to Banks - Secured (Sch. F)
Notes Payable to Banks - Unsecured (Sch. F)
Amounts Payable to Others (Secured)
Amounts Payable to Others (Unsecured)
Accounts Payable (including credit cards)
Taxes Payable
Real Estate Mortgages Payable (Schedule C, D)
Life Insurance Loans (Schedule B)
Due to Brokers
Other Liabilities (itemize)

Annual 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 debt.

Salary, Bonuses & Commissions (Applicant)
Salary, Bonuses & Commissions (Co-Applicant)
Dividends & Interest
Real Estate Income
Prtnrshp/PC/LLC/S Corp Income
Other Income*

Annual Income for Year Ended

Capital Gains / Losses

Annual Expenditures

Mortgage Payments - Residential
Mortgage Payments - Investment
Interest & Principal Payments on Notes
Taxes - Federal, State, Local
Insurance
Lease / Rent Obligations
Investments (including tax shelters)
Other Living Expenses
Other Expenses

Schedule A — Securities

Include U.S. Gov't & Municipals (readily marketable) and closely held / thinly traded / restricted stock (non-readily marketable).

Type	Description	Owner(s)	No. of Shares / Face Value	Market Value	Pledged

Schedule B — Life Insurance

Insurance Company	Face Amount	Type of Policy	Beneficiary	Cash Surrender Value	Amount Borrowed	Ownership

Schedule C — Personal Residence & Real Estate Investments

Personal Residence

Property Address

Legal Owner

Purchase Year

Purchase Price

Percent Owned

Market Value

Present Loan Balance

Monthly Payment

Lender

Investment Properties (include Real Estate Partnerships)

Property Address	Legal Owner	Purchase Year	Purchase Price	% Owned	Market Value	Present Loan Balance	Monthly Payment	Lender

Schedule D — Non-Real Estate Business Ventures

Business Name	Legal Owner(s)	Position / Title	% Owned	Contingent Liability	Amount Contingent	Years in Business	Value of Equity Ownership

Schedule E — Contingent Liabilities

Business Name	Amount of Liability	Ownership %	Comments

Schedule F — Cash in Banks & Notes Payable to Banks

Name of Bank	Type of Account	Type of Ownership	On Deposit	Notes Due to Banks	Collateral

Please Answer the Following Questions

1. Income tax returns filed through (date)

Are any returns being audited or contested?

Yes No

2. Have either of you, or any entity in which you were a >20% owner, ever declared bankruptcy?

Yes No

3. Have you drawn a will?

Yes No

If so, please name the executor and date the will was drawn

Certification & Signature

This information and the information provided on all accompanying schedules is provided for the purpose of obtaining or monitoring credit for the Applicant(s), or for the purpose of the Applicant(s) guaranteeing credit for others. The Applicant(s) acknowledge that representations made in this Statement will be relied on by the Creditor in its decision to grant credit, and that this Statement is true and correct in every detail and accurately represents the financial condition of the Applicant(s) as of the date given. The Applicant(s) authorize the Creditor to make all inquiries necessary to verify the accuracy of this Statement, and understand that knowing or willful false statements may constitute a violation of federal law and may result in fines or imprisonment. By signing below, each Applicant authorizes the Creditor to check their credit and employment history and obtain a credit report.

Signature (Applicant) — type full name to sign

Date Signed

Signature (Co-Applicant / Other Party) — if applicable

Date Signed

I certify that the information provided in this Personal Financial Statement is true, complete, and accurate to the best of my knowledge. *