PERSONAL FINANCIAL STATEMENT

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1 FCB FIRST COMMERCIAL BANK, N.A. SEGUIN NEW BRAUNFELS JOURDANTON PEARSALL SAN ANTONIO PERSONAL FINANCIAL STATEMENT EFFECTIVE DATE Name Social Security No. Date of Birth City State Zip Cell Home Work Employer Position Spouse s Name Social Security No. Date of Birth City State Zip Cell Home Work Employer Position BALANCE SHEET ASSETS LIABILITIES & NET WORTH Cash Sch. 1 Credit Cards Payable Marketable Securities Sch. 2 Taxes Payable Non-Marketable Securities Sch. 3 Notes Payable - FCB Sch. 9 Accounts Receivable Notes Payable - Other Sch. 9 Notes Receivable Sch. 4 Homestead Mortgage Sch. 6 Cash Value Life Insurance Sch. 5 Student Loans Retirement Accounts Non-Homestead Mortgages Sch. 7 Automobiles Business Interest Debt Sch. 8 Furniture/Fixtures Other Liabilities (Itemize Below) Other Personal Property Homestead Sch. 6 Investment Real Estate Sch. 7 Business Interests Sch. 8 Other Assets (Itemize Below) Liabilities Net Worth (assets - liabilities) Assets Liabilities & Net Worth Rev Page 1 of 5

2 Schedule 1 - Cash Name of Bank Year Opened Account Account Name Current Schedule 2 Marketable Securities No. of Shares Cost Per Share Market Value Per Share* Value Pledged? Restricted? Schedule 3 Non-Marketable Securities No. of Cost Per Shares Share Market Value Per Share* Value Pledged? Restricted? Schedule 4 Notes Receivable Original Due From Current Monthly Payments Maturity Collateral Schedule 5 Life Insurance Insurance Person Company Covered Beneficiary of Policy Face Value Cash Value Pledged Is it Assigned? Page 2 of 5

3 Schedule 6 Homestead Real Estate Year Acquired Cost Market Value* Lienholder Mo. Pmt. Mortgage Schedule 7 Investment Real Estate Year Acquired Ownership % Cost Market Value* Lienholder Loan Monthly Loan Payment Monthly Taxes & Ins. Monthly Rental Income *Date & Source of Value Schedule 8 Business Interests (Non Real Estate) Ownership Business Initial Investment Market Value* Related Debt % Schedule 9 Notes Payable Due To Original Current Monthly Payments Maturity Collateral FCB Other Page 3 of 5

4 Contingent Liabilities - Any loan, lease, contract, or other debt/obligation you guarantee or cosign. Also list other potential future liabilities. Debt in the Name of Your Capacity (guarantor, co-maker) PERSONAL INFORMATION Income taxes are settled through what year? Do you have a will? Yes No Who is the Executor? Are you a partner or officer in any other venture? Yes No Explain: Are any assets pledged other than as described on schedules? Yes No Explain: Are you currently a party to any law suits or legal actions? Yes No Explain: Have you declared bankruptcy in the past 10 years? Yes No State year and Explain: Are you the beneficiary or grantor of any trust? Yes No Explain: ANNUAL CASH FLOW Sources of Cash Prior Year Current Year Uses of Cash Prior Year Current Year Salaries Commissions & Bonuses Rental Income Dividend & Interest Income Account Receivable Income Sale of Assets (Describe) Distributions from Businesses Oil & Gas Income Alimony / Child Support Income Other Sources of Income Personal Expenses Mortgage Payment Income Taxes Business Requirements (Partnerships, contributions, capitalizations, etc.) Alimony / Child Support Payments Other Uses of Cash Cash Received Cash Used Cash flow Surplus or Deficit (received used) (Alimony / Child Support Income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation) Page 4 of 5

5 IMPORTANT PLEASE READ BEFORE SIGNING The undersigned hereby consent to First Commercial Banks s use of a non-business consumer credit report on the undersigned in order to further evaluate the credit worthiness of the undersigned as principal(s), proprietor(s), and/or guarantor(s) in connection with an extension of credit or, from time to time, in connection with a continuation of credit. The undersigned hereby knowingly consent to the use of such credit report consistent with the Federal Fair Credit Reporting Act as contained in 15 et seq. The information contained in this statement is provided for the purpose of obtaining, or maintaining credit with First Commercial Bank FCB on behalf of the undersigned, or persons, firms or corporations in whose behalf the undersigned may either severally or jointly with others, execute a guaranty in FCB s favor. Each undersigned understands that FCB is relying on the information provided herein (including the designation made as to ownership of property) in deciding to grant or continue credit. Each undersigned represents and warrants that the information provided is true and complete and that FCB may consider this statement as continuing to be true and correct until a written notice of a change is given to FCB by the undersigned. FCB is authorized to make all inquiries deemed necessary to verify the accuracy of the statements made herein, and to determine my/our creditworthiness. FCB is authorized to answer questions about their credit experience with me/us. Signature Date Signature Date Additional Space if Needed: Page 5 of 5

PERSONAL FINANCIAL STATEMENT. In Dollars (Omit cents)

PERSONAL FINANCIAL STATEMENT. In Dollars (Omit cents) PERSONAL FINANCIAL STATEMENT IMPORTANT: Read these directions before completing this Statement. If you are applying for individual credit in your own name and are relying on your own income or assets of