PERSONAL FINANCIAL STATEMENT



[pic] PERSONAL LOAN APPLICATION

DATE:      , 20     

• If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete all Sections except Section B.

• If you are applying for joint credit with another person, complete all Sections providing information in Section B about joint applicant, OR request joint applicant to complete a separate personal loan application or personal financial statement.

|TYPE OF CREDIT REQUESTED: |

|AMOUNT REQUESTED: |FOR HOW LONG |PAYMENT DUE DATE |WANT TO REPAY |PROCEEDS TO BE USED FOR: |

|      |      |DESIRED |MONTHLY |      |

| | |      |      | |

|SECTION A - YOU | SECTION B - OTHER PARTY |

|Name (First, Middle, Last) Date of Birth       Education Yrs.       |Name (First, Middle, Last) Date of Birth       Education Yrs.       |

|      |      |

|Present Address: Number of Years:      Own Rent |Present Address: Number of Years:      Own Rent |

|Street |Street       |

|City/State/       |City/State       |

|Zip       |Zip       |

|Former address if less than 2 years at present address      |Former address if less than 2 years at present address      |

|Street       |Street       |

|City/State/       |City/State/       |

|Zip       |Zip       |

|Years at former address       Own Rent |Years at former address       Own Rent |

|Name and Address of Employer |Years employed in this line of Work |Name and Address of Employer |Years employed in this line of Work |

|      |or Profession?      yrs. |      |or Profession?      yrs. |

|      |Years on this job       |      |Years on this job       |

| |Self Employed | |Self Employed |

|Position/Title       Type of Business       |Position/Title       Type of Business       |

|Salary $       Other Income* $      |Salary $       Other Income* $      |

|Social Security Number       |Social Security Number       |

|Home Phone       Business Phone       |Home Phone       Business Phone       |

|Name & Address of Nearest Relative Not Living With You: |Name & Address of Nearest Relative Not Living With You: |

|      |      |

*Exclude Alimony and child support separate maintenance payments if you do not wish this income to be considered as a basis for repaying any obligation.

|ASSETS |LIABILITIES |

|TYPE |DESCRIBE|VALUE |TYPE |DESCRIB|PAYMENT |

| | | | |E | |

|Are there any outstanding judgments against you? | | |Have you ever declared bankruptcy? | | |

|Are you a party to any lawsuit? | | |Pay alimony, child support payments? | | |

|Are you a U.S. Citizen? | | |If “No” are you a resident alien? | | |

|Have you had property foreclosed or given title or Deed in lieu | | |Are you a co-maker or guarantor on any loan contract? If | | |

|thereof in the last 7 years? | | |yes, to whom? | | |

|COMPLETE BELOW ONLY FOR HOME PURCHASE, REFINANCE, IMPROVEMENT LOANS |

|INFORMATION FOR GOVERNMENT MONITORING PURPOSES |

|The following information is requested by the Federal Government for certain types of loans related to a dwelling, in order to monitor the Lender’s compliance with |

|equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law |

|provides that a Lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, |

|under Federal regulations this Lender is required to not race and sex on the basis of visual observation or surname. If you do not wish to furnish this above |

|information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the Lender is subject|

|under applicable state law for the particular type of loan applied for.) |

|BORROWER |I do not wish to furnish this information. |CO-BORROWER |I do not wish to furnish this information. |

|Ethnicity: | Hispanic or Latino Not Hispanic or Latino |Ethnicity: | Hispanic or Latino Not Hispanic or Latino |

|Race/National | American Indian or Alaskan Native Asian |Race/National | American Indian or Alaskan Native Asian |

|Origin: | Black or African American Native Hawaiian or Other Pacific |Origin: | Black or African American Native Hawaiian or Other |

| |Islander White | |Pacific Islander White |

|Sex: | Female Male |Sex: | Female ( Male |

|To Be Completed by |Application Taken by: |Loan Officer Name: | |

|Loan Officer: |Face-to-face interview Mail Telephone |      | |

| |Date Received: | | |

The information contained in this statement is provided to Capital Bank for the purpose of obtaining, or maintaining credit on behalf of the undersigned. Capital Bank may keep this application whether or not the loan request is approved. I/We understand that the Bank is relying upon the information provided herein (including the designation made as to ownership or property) in deciding to grant or continue credit. I/We represent and warrants that the information provided is true and complete and that the Bank may consider this statement as continuing to be true and correct until a written notice of a change is given by the undersigned. The Bank is authorized to make all inquiries deemed necessary to verify the accuracy of the statements made herein and to determine my/our creditworthiness. The Bank is authorized to answer questions about its credit experience with me/us. If approved for a loan, Bank may verify information the Applicant provides to Bank either before or after the loan is closed. The applicant authorizes a financial institution(s) with whom the Applicant has current/existing banking relationships to provide Bank with any and all information and documentation that the Bank may request. By signing this application I/we understands, represents and agrees that if this application is approved, the written loan documents will represent the final agreement between the parties, there will be no unwritten oral agreements between the parties, and the written loan documents may not be contradicted later by evidence of any prior, contemporaneous, or subsequent oral agreements or understandings of the parties. I/We understand that it is a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts on the application as applicable under the provisions of Title 18, USC § 1014.

_____________________________________________ __________ __________________________________________ ___________

SIGNATURE DATE SIGNATURE (I acknowledge I am a joint applicant). DATE

CAPITAL BANK IS AN EQUAL HOUSING LENDER FDIC INSURED

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