FINANCIAL STATEMENT – BORROWER INFORMATION BANK …
FINANCIAL STATEMENT ? BORROWER INFORMATION
BANK OF NORTH DAKOTA STUDENT LOAN SERVICES
SFN 60290 (04-2018)
Section 326 of the USA PATRIOT Act1 requires us to ask for your Social Security Number. The principal purpose and routine uses of this information are to verify your identity, provide for the servicing of your account or loan, including communications with consumer reporting agencies, and in the event it is necessary, to locate you and collect on your loan(s). Providing any requested information is mandatory in order to receive the requested service. We may not be able to grant the service if the requested information is not provided.
1 This notice also satisfies our obligations under the Privacy Act of 1974.
Last Name
First Name
MI
Social Security Number
Degree Earned
Date of Birth (mm/dd/yyyy)
Telephone Number (include area code)
Current Employer Name Employer Street Address Employment Start Date (mm/dd/yyyy)
Position/Title City Previous Employer Name
Monthly Gross Income
$
State ZIP Code
Previous Employment Length
Additional Monthly Income to be Considered
$
Source of Income
OUTSTANDING DEBT PAYMENT (do not include insurance, utilities or normal monthly household bills) ? if you require additional space, please make a copy and attach the additional page
Monthly Debts
Monthly Payment
Total Owed
Name of Creditor
BND Use
BND Comments
Rent *
$
$
$
$
Mortgage Payment
$
$
$
$
Home Equity Loan
$
$
$
$
Child Support/Alimony
$
$
$
$
Auto Loan
$
$
$
$
Auto Loan
$
$
$
$
Bank/Credit Union Loan $
$
$
$
Bank/Credit Union Loan $
$
$
$
Credit Card
$
$
$
$
Credit Card
$
$
$
$
Credit Card
$
$
$
$
Credit Card
$
$
$
$
Credit Card
$
$
$
$
Other
$
$
$
$
TOTAL MONTHLY DEBT
$
$
$
$
Student Loan
$
$
$
$
Student Loan
$
$
$
$
Student Loan
$
$
$
$
Student Loan
$
$
$
$
Student Loan
$
$
$
$
Student Loan
$
$
$
$
Student Loan
$
$
$
$
Student Loan
$
$
$
$
TOTAL STUDENT LOAN DEBT
$
$
$
$
Please provide the following documents: ? Most recent federal income tax return (provide supporting documentation when applicable, e.g., Schedule K-1) ? Two most recent pay stubs from your current employer ? Documentation on any additional income you would like considered
* Rental Agreement, if applicable
Borrower Signature
Date (mm/dd/yyyy)
................
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