Personal Financial Statement FORM by hedongchenchen

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									.PERSONAL FINANCIAL STATEMENT OF:
            (APPLICANT)                                                                             (CO-APPLICANT)

             SOCIAL SECURITY NO.                           DATE OF BIRTH                        SOCIAL SECURITY NO.                           DATE OF BIRTH

                      ADDRESS                                                                            ADDRESS



    This statement has been prepared as of:

ASSETS                                                                             LIABILITIES
Cash (1)                                                    $               -      Notes Payable - Unsecured (5)                               $             -
Investments - Bonds and Stocks (2)                                                 Notes Payable - Secured (5)
Accounts & Notes Receivable (3)                                                    Loans on Life Insurance (6)
Real Estate Owned (4)                                                       -      Real Estate Mortgages (4)                                                 -
Cash Value of Life Insurance                                                       Installment Loans
Auto          Year        Make                                                     Open Accounts
Auto          Year        Make                                                     Federal Income Tax
Other (itemize)                                                                    Other Liabilities (itemize)
   Jewlery and Furs
                                                                                   Total Liabilities                                                         -
                                                                                   Net Worth                                                                 -
Total Assets                                                $               -      Total Liabilities and Net Worth                             $             -

SOURCES OF INCOME                                                                  PERSONAL INFORMATION
Salary (Applicant)                                                                 # of Dependents (Applicant)                                Ages:
Salary (Co-Applicant)                                                              Alimony Payments $/Term
Bonus & Commissions (Applicant)                                                    Support Payments $
Bonus & Commissions (Co-Applicant)                                                 # of Dependents (Co-Applicant)                             Ages:
Dividends & Interest (Applicant)                                                   Alimony Payments $/Term
Dividends & Interest (Co-Applicant)                                                Support Payments $
Rents & Royalties
Other (itemize)                                                                   Alimony-child support -- inclusion of alimony, separate maintenance,
                                                                                  or child support as income is voluntary. If you choose to include such
Annual Income                                               $               -     payments, please describe it by the court and case number, the amount,
                                                                                  and the name and address of the person obligated to pay that amount
                                                                                  to you. If you are responsible for paying alimony, separate maintenance
                                                                                  or child support, please give particulars of that obligation, along with
                                                                                  your other obligations.




Contingent Liabilities                     Applic               Co-Applicant       Brief description:
Endorser of comaker on note                Y or N                 Y or N
Defendant in any legal action              Y or N                 Y or N
Letters of Credit                         Y or N                  Y or N


The Federal Equal Credit Opportunity Act prohibits creditors from discrimination against applicants; on the basis of race, color, religion, national orgin
sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income
derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection
Act. The federal agency that administers compliance with this law concerning the creditor is the Comptroller of the Currency, Consumer Affairs
Division, Washington, D.C. 20219.
                                        Schedules


SCHEDULE 1 - CASH
  NAME OF BANK OR SAVINGS                               TYPE OF
   AND LOAN ASSOCIATION          TITLE OF ACCOUNT       ACCOUNT           AMOUNT




TOTAL CASH                                                            $             -

SCHEDULE 2 - INVESTMENTS - BONDS & STOCKS
                                  REGISTERED                              MARKET
       DESCRIPTION                 IN NAME OF           NO. SHARES         VALUE




TOTAL INVESTMENTS                                                     $             -

SCHEDULE 3 - ACCOUNTS & NOTES RECEIVABLE
        OWNED BY              MATURITY/AMT DUE          SECURITY




TOTAL ACC & NOTES REC                                                 $             -

SCHEDULE 4 - REAL ESTATE OWNED
                                                         MARKET           MONTHLY
        DESCRIPTION                 L0CATION              VALUE           PAYMENTS




TOTAL REAL ESTATE                                   $             -   $             -

SCHEDULE 5 - NOTES PAYABLE
         OWED TO                     AMOUNT             DUE DATE          PAYMENT




                                         Page 7
                                                                  Schedules


TOTAL NOTES PAYABLE                               $                              -

I (We) confirm that this financial statement is given to you by me (us) for the purpose of obtaining credit from time to time;
that I (We) have read the same and that it is true and complete. I (We) agree that if, in your sole opinion, this financial
statement is found to be incorrect, any one or more of all of my (our) obligations to you, at your sole discretion, may be
matured by you without demand upon or notice to me (us).


Applicant signature_______________________________________ Date_________________________


Co-Applicant signature____________________________________ Date_________________________




                                                                    Page 8
                  Schedules




     WHERE
     PLEDGE




    MORTGAGE
     BALANCE




$             -


    SECURED BY




                   Page 9
Schedules




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