Personal Financial Statement (REV 06/2018) – Northwest Federal Credit Union Instructions

Enter Applicant 1's full legal name (first, middle initial if any, and last name).

Enter Applicant 1's Social Security Number in the usual 9-digit format (for example, 123-45-6789).

Enter Applicant 1's current street address, including apartment or unit number if applicable.

Enter Applicant 1's business or work phone number including area code and any extension if needed.

Enter the city, two-letter state abbreviation, and ZIP code for Applicant 1's address (for example, Seattle, WA 98101).

Enter Applicant 1's home or primary residence phone number including area code.

Enter Applicant 2's full legal name (first name, middle initial if any, and last name).

Enter Applicant 2's nine-digit Social Security Number (include dashes if you normally use them, e.g., 123-45-6789).

Enter Applicant 2's street mailing address including apartment or unit number if applicable.

Enter Applicant 2's business phone number including area code and extension if applicable.

Enter the city, state (abbreviation) and ZIP code for Applicant 2's mailing address (e.g., Seattle, WA 98101).

Enter Applicant 2's primary residence phone number including area code and extension if applicable.

Enter the total amount held in your cash and checking accounts.

Enter the total amount held in your savings accounts and certificates of deposit (CDs).

Enter the total balance in your IRA and other retirement accounts.

Enter the total amount of accounts and notes receivable owed to you.

Enter the cash surrender value of your life insurance policies (see Section 7 for details).

Enter the total market value of your stocks and bonds (describe holdings in Section 3).

Enter the value of real estate you own (describe properties in Section 4).

Enter the net worth value of any closely held companies in which you have ownership.

Enter the value of other personal property you own, including automobiles (describe in Section 5).

Enter the total value of any other assets not listed above (describe in Section 5).

Enter the sum total of all asset amounts listed above.

Check this box if you have any assets pledged or debts secured that are not already listed elsewhere on the form.

Check this box if you do not have any assets pledged or debts secured beyond what is already shown on the form.

Check this box if you or any entity in which you were an owner or part-owner has ever filed for or gone through bankruptcy.

Check this box if neither you nor any entity in which you were an owner or part-owner has ever filed for or gone through bankruptcy.

Provide any explanations or additional details related to Section 9 questions (for example, bankruptcy, settled debts, judgments, pledged assets, legal actions, disability insurance and monthly coverage amount), including dates, parties, amounts and other relevant facts as needed. Fill only if 'Have you, or any entity in which you were an owner or part owner, ever gone through bankruptcy? — Yes', 'Have you ever settled any debts for less than the amount owed? - Yes', 'Have you ever had a judgment against you? - Yes', 'Are any assets pledged or debts secured except as shown? — Yes', 'Are you a defendant in any suits or legal actions? - Yes' is 'Yes' (any).

Enter the total amount you are liable for as an endorser, guarantor, or co‑maker on another person’s debt.

Enter the total amount of any outstanding legal claims, judgments, or liens currently asserted against you.

Enter the amount reserved or owed for federal income taxes that remain unpaid or contingent.

Enter the total amount of any other contingent or special debts or obligations not included in the previous items.

Check this box if you currently are (or have been) a defendant in any suits or legal actions.

Check this box if you are not currently and have not been a defendant in any suits or legal actions.

Enter a clear description of each other income source included in Section 1, specifying the source, amount, and how often it is received (for example: rental income $500/month or alimony $200/week). Fill only if 'Other Income (Describe below)' has a value.

Enter the monthly amount of your disability insurance coverage in dollars (the dollar value you receive or are covered for per month). Fill only if 'Do you have Disability Insurance? — Yes' is 'Yes'.

Check this box if you do have disability insurance (answering 'Yes' to the question).

Check this box if you do not have disability insurance (answering 'No' to the question).

Provide the name of the creditor or lending institution for the fifth note payable.

Provide the original date the loan was issued for the fifth note payable.

Enter the original principal amount of the fifth loan when it was issued.

Enter the current outstanding balance remaining on the fifth loan.

Enter the interest rate charged on the fifth loan as a percentage.

Enter the required monthly payment amount for the fifth loan.

Provide the maturity (due) date when the fifth loan must be fully repaid.

Describe the collateral or security (if any) securing the fifth loan; enter 'None' if unsecured.

Enter the quantity of shares, the face value for bonds, or the percentage of ownership for this security.

Enter the name of the agency, company issuing the security, or the name of the partnership associated with this holding.

Enter the stock ticker symbol for this security if one exists, or leave blank if not applicable.

Enter the current market value of this security.

Check this box if the securities listed in the fifth stocks and bonds entry are pledged or used as collateral.

Check this box if the securities listed in the fifth stocks and bonds entry are not pledged and are not used as collateral.

Enter the name of the creditor or lender for the first note payable.

Enter the original date when the first note was issued.

Enter the original principal amount of the first note payable.

Enter the current outstanding balance remaining on the first note payable.

Enter the interest rate applied to the first note payable.

Enter the regular monthly payment amount required for the first note payable.

Enter the maturity or final due date for the first note payable.

Describe any collateral or security pledged for the first note payable (for example, property, vehicle, or account).

Enter the number of shares, face value for bonds, or percentage of ownership for the first listed security.

Enter the name of the agency, company, or partnership that issued the security for the first entry.

Enter the stock ticker symbol for the first listed security, if applicable; leave blank if none.

Enter the current market value of the first listed security.

Check this box if the first listed stock or bond entry is pledged (i.e., pledged as collateral).

Check this box if the first listed stock or bond entry is not pledged (i.e., not pledged as collateral).

Enter the name of the creditor or lender for the fourth note payable.

Enter the date the fourth loan was originally issued or originated.

Enter the original principal amount borrowed for the fourth note payable.

Enter the current outstanding balance remaining on the fourth note payable.

Enter the interest rate charged on the fourth loan as a numeric value.

Enter the required monthly payment amount for the fourth note payable.

Enter the maturity or due date when the fourth loan must be fully repaid.

Describe any collateral or security held against the fourth note payable (or indicate 'none').

Enter the number of shares, face value of bonds, or percent ownership for the fourth stocks/bonds entry.

Enter the name of the agency, company, or partnership that issued the security for the fourth entry.

Enter the stock ticker symbol for the security listed in the fourth entry, if applicable; leave blank if none.

Enter the current market value of the securities for the fourth entry.

Check this box if the fourth stocks/bonds entry listed on this row is pledged as collateral (Yes).

Check this box if the fourth stocks/bonds entry listed on this row is not pledged as collateral (No).

Enter the current outstanding balance owed on the automobile installment loan.

Enter the required monthly payment amount for the automobile installment loan. Fill only if 'Installment Account (Auto) - Balance' has a value.

Enter the outstanding principal balance owed on the first 'Other' installment account listed under liabilities.

Enter the required monthly payment amount for the first 'Other' installment account listed under liabilities. Fill only if 'Other #1 Installment Account - Current Balance' has a value.

Enter the current outstanding dollar balance owed on the other installment account identified as #2.

Enter the required monthly payment amount for the other installment account identified as #2. Fill only if 'Installment Account (Other #2) Balance' has a value.

Check this box if you have previously had a civil or court judgment entered against you.

Check this box if you have never had any civil or court judgment entered against you.

Total current balances you owe to suppliers, credit card companies, and other short-term payables.

Total outstanding bank notes, loans, and lines of credit payable to banks as described in Section 2.

Total principal balances remaining on mortgages secured by real estate you own, as detailed in Section 4.

Total amount of any federal, state, or local taxes currently unpaid or owing, as described in Section 6.

Aggregate of other debts or obligations not listed elsewhere, with details to be provided in Section 8.

Sum of all liabilities listed on this statement representing your total outstanding debts.

Difference between total assets and total liabilities representing your personal net worth.

Enter the representative original loan date for the group of notes payable (or leave blank if no single representative date applies).

Enter the combined original principal amounts for all notes payable listed in this section.

Enter the total current outstanding balance for all notes payable listed in this section.

Enter the summary interest rate for the listed notes payable (for example, a weighted average or other representative rate).

Enter the total monthly payment amount due for all notes payable combined.

Enter the representative maturity date for the notes payable (or leave blank if no single representative date applies).

Provide a brief summary of the collateral or security covering the notes payable, or enter 'None' if there is no collateral.

Enter the full street address for Property A, including street number, street name, unit/suite (if any), city, state, and ZIP code.

Enter the full street address for Property B, including street number, street name, unit/suite (if any), city, state, and ZIP code.

Enter the full street address for Property C, including street number, street name, unit/suite (if any), city, state, and ZIP code.

Enter the monthly payment amount for Property A (include PITI and any condominium or townhouse fees).

Enter the monthly payment amount for Property B (include PITI and any condominium or townhouse fees).

Enter the monthly payment amount for Property C (include PITI and any condominium or townhouse fees).

Enter the date when Property A was purchased.

Enter the date when Property B was purchased.

Enter the date when Property C was purchased.

Enter the total gross rental income received from Property A (all rental receipts before expenses) for the reporting period.

Enter the total gross rental income received from Property B (all rental receipts before expenses) for the reporting period.

Enter the total gross rental income received from Property C (all rental receipts before expenses) for the reporting period.

Enter the mortgage account number assigned by the lender for Property A as it appears on loan statements (include any letters, dashes, or account prefixes).

Enter the mortgage account number assigned by the lender for Property B as it appears on loan statements (include any letters, dashes, or account prefixes).

Enter the mortgage account number assigned by the lender for Property C as it appears on loan statements (include any letters, dashes, or account prefixes).

Enter the current outstanding mortgage balance remaining on the loan for Property A.

Enter the current outstanding mortgage balance remaining on the loan for Property B.

Enter the current outstanding mortgage balance remaining on the loan for Property C.

Enter the full name(s) of the mortgage holder(s) or lender for Property A as they appear on the mortgage documents.

Enter the full name(s) of the mortgage holder(s) or lender for Property B as they appear on the mortgage documents.

Enter the full name(s) of the mortgage holder(s) or lender for Property C as they appear on the mortgage documents.

Enter the original purchase cost paid for Property A as reported on closing (the amount originally paid for the property).

Enter the original purchase cost paid for Property B as reported on closing (the amount originally paid for the property).

Enter the original purchase cost paid for Property C as reported on closing (the amount originally paid for the property).

Enter the current market value (fair market price) of Property A as a numeric amount.

Enter the current market value (fair market price) of Property B as a numeric amount.

Enter the current market value (fair market price) of Property C as a numeric amount.

Enter the name of the creditor or lending institution for the second note payable.

Enter the date the loan was originated (the original loan date) for the second note.

Enter the original principal amount of the second loan at the time it was issued.

Enter the current outstanding balance remaining on the second note payable.

Enter the annual interest rate charged on the second note.

Enter the required monthly payment amount for the second note payable.

Enter the maturity date when the second loan is scheduled to be fully paid.

Describe the collateral or security pledged to secure the second note (for example, vehicle, real estate, or other).

Enter the number of shares, face value of bonds, or percentage of ownership for the second stocks and bonds entry.

Enter the agency, company, or partnership name that issued the security for the second stocks and bonds entry.

Enter the stock ticker symbol for the security (if applicable) for the second stocks and bonds entry.

Enter the market value of the security for the second stocks and bonds entry.

Check this box if the security listed on the second Stocks and Bonds entry is pledged or used as collateral.

Check this box if the security listed on the second Stocks and Bonds entry is not pledged and is not used as collateral.

Provide a detailed description of the other personal property or asset (Item 1); if it is pledged as security include the lien holder’s name and address, amount of lien, terms of payment, and any delinquency details.

Describe any unpaid taxes in detail, including the type of tax, the taxing authority or payee, the due date, the amount owed, and whether the tax is a lien on any property (include the property address if applicable).

Enter the life insurance policy details including face amount and cash surrender value, name of the insurance company, policy number(s) and the beneficiaries for each policy.

Enter a detailed description of any other liabilities, including the type of obligation, name of the party to whom it is payable, outstanding amount, payment terms (due dates, frequency), and any delinquency or special conditions.

Check this box if you (or the entity you owned/part-owned) have ever settled any debts for an amount less than the total owed.

Check this box if you (and any entity you owned/part-owned) have never settled any debts for less than the amount owed.

Enter the full name of the creditor or lending institution for the seventh note payable.

Enter the date when the loan was originally issued for this note.

Enter the original principal amount of the loan for this note.

Enter the current outstanding balance remaining on this note.

Enter the interest rate that applies to this note.

Enter the required monthly payment amount for this note.

Enter the maturity date when this loan becomes due.

Describe any collateral or security held against this note (for example, vehicle, real estate, or other assets).

Enter the first signer's signature (handwritten or typed name as allowed by your submission method) to authorize and certify the information on this form.

Enter the second signer's signature (handwritten or typed name as allowed by your submission method) to authorize and certify the information on this form.

Enter the name of the lender or creditor for the sixth note payable.

Enter the date the sixth note payable was originally issued.

Provide the original principal amount of the sixth note payable.

Enter the current outstanding balance remaining on the sixth note payable.

Provide the annual interest rate applied to the sixth note payable.

Enter the regular monthly payment amount required for the sixth note payable.

Enter the maturity date when the sixth note payable is due to be fully repaid.

Describe any collateral or security pledged for the sixth note payable (for example, property, vehicle, or lien).

Enter the current market value of this security holding.

Enter the quantity of shares, the face value for bonds, or the percentage of ownership for this particular holding.

Enter the full name of the agency, company, or partnership that issued the security or the name of the partnership.

Enter the stock ticker symbol for this security if one exists, otherwise leave this field blank.

Check this box if the sixth stocks or bonds entry shown on this row is pledged as collateral (Yes).

Check this box if the sixth stocks or bonds entry shown on this row is not pledged as collateral (No).

Enter the total salary and wages you receive for the reporting period.

Enter the total income from investments (for example, interest, dividends, or capital gains) for the reporting period.

Enter the total income you receive from rental properties or other real estate activities for the reporting period.

Enter the total amount of any other income not listed above and briefly describe the source in the description area below.

Enter the sum of the amounts entered for Salary, Net Investment Income, Real Estate Income, and Other Income to show your total income for the reporting period.

Enter the name of the creditor or lending institution for the third note payable.

Enter the original date the third loan/note was issued.

Enter the original principal amount of the third note as a numeric value.

Enter the current outstanding balance remaining on the third note as a numeric value.

Enter the interest rate charged on the third note as a numeric value.

Enter the required monthly payment amount for the third note as a numeric value.

Enter the maturity (final payment) date for the third note.

Describe any collateral or security held against the third note (e.g., vehicle, real estate, guaranty).

Enter the number of shares, the face value for bonds, or the percentage of ownership for this third stocks and bonds entry.

Enter the agency name, company issuing the security, or the name of the partnership associated with this third stocks and bonds entry.

Enter the stock ticker symbol for this security for the third entry, or leave blank if not applicable.

Enter the market value of this security for the third stocks and bonds entry.

Check this box if the stock(s) or bond(s) listed on the third Stocks and Bonds row are pledged as collateral.

Check this box if the stock(s) or bond(s) listed on the third Stocks and Bonds row are not pledged as collateral.