Personal Financial Statement - US Bank
PFS for CONFIDENTIAL Page 2 of 3
Please contact your banker if you need assistance with completing these schedules. Round all amounts to the nearest $100.
* ANNUAL INCOME APPLICANT CO-APPLICANT PLEASE ANSWER EACH QUESTION (Yes / No) APP. CO-APP
Salary
Bonuses/Commissions
Are you a Co-Maker, Endorser or Guarantor of
any other person’s debt?
Dividends/Interest
Net Real Estate Income
Are you a defendant in any suit or legal action?
* Income from alimony, child support, or
maintenance payments need not be entered
unless you want it considered as a base for
repayment.
Have you ever gone through bankruptcy or had a
judgment against you?
Other (List)
Total 0 0
Have you made a will?
SCHEDULE 1 / CASH, SAVINGS, CERTIFICATES AND IRA ACCOUNTS
Name of Bank or Financial Institution Type of Account Acct. Balance
Total $ 0
SCHEDULE 2 / SECURITIES OWNED
Par Value or
No. of Shares Description
Registered in
Name(s) of
Listed or
Unlisted
Current Market
Value
Total $ 0
SCHEDULE 3 / LIFE INSURANCE
Insurance Company Insured Beneficiary
Face Value
of Policy
Cash Value
of Policy Loans
Total $ 0 0
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