PERSONAL FINANCIAL STATEMENT

As of _________________________

Complete this form for any person providing a guaranty on the loan.
Name: Business Phone:

Residence Address: Residence Phone:

City, State & Zip Code Date of Birth:

Business Name of Applicant / Borrower:

ASSETS LIABILITIES
Cash on Hand & in Banks $ Accounts Payable $
Savings Accounts $ Notes Payable to Bank and Others
$
IRA or Other Retirement Accounts $ (Describe in Section 2)
Accounts & Notes Receivables $ Installment Accounts (Auto)
$
Life Insurance-Cash Surrender Value Only
$
(Complete Section 8) Installment Accounts (Other)
$
Stocks & Bonds
$
(Describe in Section 3) Loan on Life Insurance
$
Real Estate
$
(Describe in Section 4) Mortgages on Real Estate
$
Automobile-Present Value $ (Describe in Section 4)
Other Personal Property Unpaid Taxes
$ $
(Describe in Section 5) (Describe in Section 6)
Other Assets Other Liabilities
$ $
(Describe in Section 5) (Describe in Section 7)
Total Assets $ Total Liabilities $
$
Net Worth
Section 1. Source of Income: Contingent Liabilities:
Salary $ As Endorser or Co-Maker $
Net Investment Income $ Legal Claims & Judgments $
Real Estate Income $ Federal Income Tax $
Other Income Other Debt
$ $
(Describe below)

Description of Other Income in Section 1.

Section 2. Amounts Owed to Creditors.

Secured/Unsecured

Secured/Unsecured

1
Section 3. Stocks and Bonds. (Top three investment by value.)
Number of Name of Issuer of Market Value Date of
Cost Total Value
Shares Securities Quotation / Exchange Quotation / Exchange

Section 4. Real Estate Owned. (List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part
of this statement and signed.)
Property A Property B Property C
Type of Property
Address

Date of Purchase
Original Cost $ $ $
Present Market Value
Name & Address
(Mortgage Holder)

Mortgage Account
Number
Mortgage Balance $ $ $
Amount of Payment Month: Year: Month: Year: Month: Year:
(Month / Year)
$ $ $ $ $ $
Section 5. Other Personal Property and Other Assets. (Describe, and if any is pledged as security, state name and address of
lien holder, amount of lien, terms of payment, and if delinquent, describe delinquency.)

Section 6. Unpaid Taxes. (Describe in detail, including type, to whom payable, when due, amount, as to what property, and if delinquent,
describe delinquency.)

Section 7. Other Liabilities. (Describe in detail.)

Section 8. Life Insurance Held. (Give face amount, cash surrender value of policies, name of insurance company, and beneficiaries.)

I HEREBY REPRESENT AND WARRANT THAT THE FOREGOING INFORMATION CONTAINED IN THIS FINANCIAL STATEMENT, AND ANY
INFORMATION PROVIDED IN CONNECTION WITH IT, IS TRUE AND CORRECT AND PRESENTS FAIRLY IN ALL MATERIAL RESPECTS MY
FINANCIAL CONDITION. I HEREBY IRREVOCABLY AND CONTINUOUSLY AUTHORIZE ALLY FINANCIAL INC. (ALLY) TO OBTAIN FROM
AND PROVIDE TO THIRD PERSONS, FROM TIME TO TIME, ANY AND ALL PERSONAL, FINANCIAL, BUSINESS AND OTHER
INFORMATION ABOUT ME TO INVESTIGATE THE INFORMATION IN THIS FINANCIAL STATEMENT AND TO ASSES MY CREDIT
WORTHINESS (INCLUDING OBTAINING A CONSUMER CREDIT REPORT). FURTHER, I PROMISE TO NOTIFY ALLY IMMEDIATELY (A) IF
MY NET WORTH AS SHOWN ON THIS FINANCIAL STATEMENT DECLINES BY 25%. (B) IF MY CONTINGENT LIABILITY, AS RECORDED,
INCREASES BY 25% OF MY NET WORTH OR (C) IF A COMBINATION OF NET WORTH DECLINE AND CONTINGENT LIABILTY INCREASE,
TOTALS 25% OF MY NET WORTH.
Signature: Date: Social Security Number:
Signature: Date: Social Security Number: