CUSTOMER’S PERSONAL FINANCIAL STATEMENT OF AFFAIRS    Download & Print Printer Friendly Version

Prefered Branch:
Applicant: Surname* Christian Name * Spouse Surname Christian Name
       
Date Of Birth
(dd/mm/yyyy)* 		Marital Status No. Of Dependents* Address*
  Telephone Nos*
PREVIOUS ADDRESS (if at above for less than 2 years) AT PRESENT ADDRESS FOR*  YEARS TRN*
*  PER MONTH
EMPLOYER (Name & Address) Position Length of Service Gross Annual
Salary*
Telephone No.

PREVIOUS EMPLOYER (if at above for less than 2 years)

SPOUSE’S EMPLOYER (Name & Address)

 Position Length of Service Gross Annual
Salary
Telephone No.
ACCOUNTS AT OTHER BANKS/ Branch IF NEW LOAN ACCOUNT, RECORD IDENTIFICATION DETAILS
(e.g. Driver’s Licence Number)		 OTHER INCOME – SOURCE(S) & AMOUNT(S)
DETAILS OF ASSETS & LIABILITIES
(If item marked * is more than one, list overleaf with description)
DESCRIPTION ASSETS At C/V DESCRIPTION LIABILIITES
REAL ESTATE

LOAN(S) ON REAL ESTATE*
MOTOR VEHICLE(S)*

LOAN(S) ON MOTOR VEHICLE(S)*
FURNITURE & EQUIPMENT LOAN ON FURNITURE & EQUIPMENT
LIFE INSURANCE
CASH SURRENDER VALUE
(Not Life Cover)		 CURRENT ACCOUNT OVERDRAFT

CREDIT CARDS
OTHER NON-CASH ASSETS*
(Describe overleaf) -

OTHER LOANS PAYABLE BY YOU*
(Describe overleaf)
AMOUNTS OWED TO YOU
Describe here:

OTHER LIABILITIES NOT DESCRIBED ABOVE
(Describe here)
SAVINGS/DEPOSITS ACCOUNTS:
FGB
OTHER		 SUB-TOTAL(2)
OTHER INVESTMENTS
(Describe overleaf)		 NET WORTH (at C/V)(1) minus (2)
NET WORTH (at M/V)(1) minus (2)
TOTAL(1)

TOTAL
DETAILS OF LIFE INSURANCE POLICIES HELD
INSURANCE COMPANY SUM INSURED ANNUAL PREMUM REMARKS (Assigned, etc.)
PROJECTED MONTHLY CASH FLOW
NOTE: For accuracy, compute ANNUAL and divide by 12
OUTFLOWS INFLOWS
SHELTER
(Rent/Mortgage, Property Taxes, Property Insurance, Maintenance, etc.)		 GROSS MONTHLY SALARY & BENEFITS
(Based on official income verification from employer)
OTHER INSTALMENT PAYMENTS
(Loans, Life Insurance, Credit Card Payments,
Savings, etc.)		 SELF-EMPLOYED INCOME (NET)
(Audited accounts or statement from Chartered Accountant attached)
UTILITIES
TRANSPORTATION
(Gas, Car Insurance License, Maintenance, etc. or
Cost of Public Transportation)		 OTHER INCOME
(Give detail(s) include estimated rent (if any) from real estate owned or being acquired)
OTHER LIVING EXPENSES
(Food, Clothing, Medical, School, Entertainment, etc.)		 LESS STATUTORY DEDUCTIONS AT SOURCE
(Income Tax, NHT, etc.)
TOTAL OUTFLOWS TOTAL INFLOWS
SUBTRACT TOTAL OUTFLOWS
RESIDUAL INCOME AFTER>>
PARTICULARS OF REAL ESTATE HOLDINGS

ADDRESS(ES)

VALUATION

EXISTING
LOAN BALANCE

MONTHLY
PAYMENT

ACCOUNT
NUMBER

LENDER
1  
2  
3  
4  
5  
Total
PARTICULARS OF MOTOR VEHICLE
type year & model value loan
balance 		monthly
payment
1          
2          
3          
total
PARTICULARS OF OTHER NON-CASH ASSETS, INVESTMENTS, ETC.
DESCRIPTION value
1    
2    
3    
4    
total
PARTICULARS OF OTHER LIABILITIES (PAYABLE OR GUARANTEED BY YOU)
Creditor PURPOSE OF LOAN BALANCE monthly payment
1        
2        
3        
4        
5        
total
PERSONAL REFERENCES (1 Relative & 1 Friend)
1 NAME:*   TELEPHONE #S:*
Address:*     Home Wwork Ccell
2 NAME:*   TELEPHONE #S:*
Address:*   Home Work Cell
 I ACCEPT*

I/We certify that the information I/we provided on this application is correct and complete. You may, from time to time, give any credit and other information about me/us, including any information on this Form to and receive such information from, any: (a) Credit Bureau or Reporting Agency; (b) Person with whom I may have or propose to have financial dealings; (c) First Global Bank Limited and its subsidiaries or affiliates; and (d) Person in connection with any dealings I have or propose to have with you.

We undertake to immediately advise you in writing of any change in any form of identification including but not limited to change of names and addresses and agree to provide such documentation as may be relevant.

I/we agree that you may use that information to establish and maintain any relationship with you and to offer me any services from time to time as permitted by law.