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Page 1 of 2 CitiFinancial, Inc. PERSONAL LOAN APPLICATION 300 St. Paul PLEASE COMPLETE THE ENTIRE APPLICATION IN BLUE OR BLACK INK. Baltimore MD, 21202 PLEASE RETAIN A COPY OF THE COMPLETED APPLICATION FOR YOUR RECORDS. 1. Tell Us About Yourself First Name MI Last Name Social Security Number - - Home Phone Number Cell Phone Date of Birth / / (mm / dd / yyyy) At least one phone number must be entered. What is the best time to contact you? am. /pm. Time Zone EST CST MST PST HST Street Address Apt./Unit Number City State Zip Code Is this your mailing address? Yes No How long at your current address? Years Months Previous Home Address 1 Previous Home Address 2 Street Address Street Address Apt./Unit Number Apt./Unit Number City State Zip Code City State Zip Code How long at this address? Years Months How long at this address? Years Months 2. Tell Us About Your Work and Finances Date Hired Employer Name Job Title/Position Date Retired / / (mm / dd / yyyy) Please check the appropriate box. Work Phone Work Extension Gross Salary / Pension Annual Monthly Other Income Annual Monthly If unemployed, you can enter your other income here. Alimony, child support, or separate maintenance income need not be revealed if the applicant does not wish to have it considered as a basis for determining credit worthiness, including applicant's ability to repay this obligation. Previous Employer 1 Previous Employer 2 Employer Name Employer Name Job Title/Position Job Title/Position Date Hired / / (mm / dd / yyyy) Date Hired / / (mm / dd / yyyy) Do you currently rent or own your home? Rent Own What is the monthly rent or mortgage? Do you have additional expenses? Yes No What is the monthly amount of the additional expenses? If you have additional expenses enter your monthly amount here. If you do not have any additional monthly expenses skip this question and proceed to the next line. 3. Tell Us About Your Co-borrower (optional) First Name MI Last Name Social Security Number - - Page 2 of 2 CitiFinancial, Inc. PERSONAL LOAN APPLICATION 300 St. Paul PLEASE COMPLETE THE ENTIRE APPLICATION IN BLUE OR BLACK INK. Baltimore MD, 21202 PLEASE RETAIN A COPY OF THE COMPLETED APPLICATION FOR YOUR RECORDS. 3. Tell Us About Your Co-borrower (optional) / cont'd Does your co-borrower reside with you? Yes No If co-applicant does NOT reside with you, please complete their address information on the following page.-- Street Address Apt./Unit Number City State Zip Code How long at your current address? Years Months Employer Name Date Hired / / (mm / dd / yyyy) Work Phone Work Extension Gross Salary / Pension Annual Monthly I/We certify that the above information is complete and accurate and that this request is not for any business or commercial purpose. You are authorized to investigate my/our credit and employment histories. I/We certify that I/we are interested in exploring other credit opportunities with you and your affiliates and hereby authorize you, at your sole discretion, to share credit information from time to time with affiliates and subsidiaries for their independent evaluation. California Residents: Any married applicant may apply for a separate account. Signature Date Applicant Signature Date Co-Applicant By submitting this Loan application, I acknowledge that I have read the legal information and the Privacy Promise (link to the Privacy Promise). I authorize CitiFinancial to receive and exchange information and investigate the references and data collected pertinent to my creditworthiness. I represent that the information I have given CitiFinancial regarding my financial condition is complete and correct and that I have no present intention to file for bankruptcy. I will notify CitiFinancial of any material adverse change in my financial condition. A consumer report is usually obtained and reviewed in the evaluation of an application. Upon request, you will be informed whether a consumer report was requested and of the name and address of the credit reporting agency furnishing any such report. Subsequent consumer reports may be requested and used in connection with an update, renewal or extension of credit. About CitiFinancial CitiFinancial is a leading provider of personal and home equity loans with more than 1,800 offices across the country. This year CitiFinancial is lending more than $4 billion to individuals and families. CitiFinancial is a member of Citigroup, a $1 trillion family of financial services companies. CitiFinancial, Inc.: AZ, CT, DE, HI, ID, IA, KS, KY, LA, ME, MD, MI, MS, MT, NE, NV, NM, NY, NC, ND, OH, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. AZ: Mortgage Banker License No. BK 0015448. CitiFinancial Corporation: CO. CitiFinancial Corporation, LLC: AL. CitiFinancial Company: NY. NY: Licensed Mortgage Banker - N.Y.S. Banking Department. CitiFinancial Services, Inc.: CA, CT, FL, GA, IL, IN, MA, MN, MO, NV, NJ, NC, OK, PA, TN, UT, VA. CA: Loans made or arranged pursuant to Department of Corporations California Finance Lenders License. GA: Georgia Residential Mortgage Registrant No. 6335; principal office, 300 St. Paul Place, Baltimore, MD 21202. NJ: Licensed Mortgage Banker - N.J. Department of Banking and Insurance; principal office, T. J. Maxx Plaza, 1350 Hooper Avenue, Suite 4-A, Toms River, NJ 08753, Telephone: 732/557-5047. MA: Mortgage Lender License Nos. ML1535, ML1536, ML1537, ML1538, ML1539, ML1540, ML1541, ML1542, ML1543, ML1544, ML1545, ML1546, ML1547, ML1548, ML1549, ML1550, ML1551, ML1552, ML1553, ML1650, ML1824, ML1900. CitiFinancial Equity Services, Inc.: FL. CitiFinancial Consumer Services: NH. Licensed by the New Hampshire Banking Department. CitiFinancial Consumer Services, Inc.: RI. RI: Licensed as a Lender and Small Loan Lender by Department of Business Regulation. CitiFinancial of Virginia, Inc.: VA. CitiFinancial Real Estate Services, Inc.: MS. Notice to Married Wisconsin Residents: No provision of a marital agreement, unilateral statement, or court decree under Wisconsin's Marital Property Act adversely affects our rights with respect to your account, unless, before we extend credit to you, you provide us with a copy of it, or we have actual knowledge of the adverse provision when the obligation is incurred. Notice to Residents of Alaska, Arkansas and Washington, D.C.: CitiFinancial does not have the authority to make loans in these jurisdictions and we are unable to accept applications from residents of these jurisdictions. We regret any inconvenience to you.
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