Spreadsheet: 27ea09ca-f590-4004-8b05-e526125690be
Sheet: Personal Financial Statement

To protect your privacy, this statement should NOT be emailed after it is completed.   You should print this statement, sign and mail it to your Relationship Manager.
 |  |  |  |  |  | PERSONAL FINANCIAL STATEMENT
IMPORTANT: Please read and check off one of the following statements  (If applying for joint credit, both parties must also initial in the appropriate area)
 | This personal financial statement is being offered in conjunction with an individual application for consumer / business purpose credit, for an extension or renewal of such credit, or compliance with annual financial reporting requirements.  Please complete Sections 1, 3, and 4.
 | This personal financial statement is being offered in conjunction with a joint application for consumer/ business purpose credit, for an extension or renewal of such credit, or compliance with annual financial reporting requirements.  Please complete Sections 1, 2, 3, and 4 and initial below.
 |  | Applicant |  |  |  |  | Co-Applicant
Section 1 - Individual Information |  |  |  |  |  | Section 2 - Other Party Information
Name |  |  |  |  |  | Name
Address |  |  |  |  |  | Address
City, State, & Zip |  |  |  |  |  | City, State, & Zip
Position or Occupation |  |  |  |  |  | Position or Occupation
Business Name |  |  |  |  |  | Business Name
Business Address |  |  |  |  |  | Business Address
City, State & Zip |  |  |  |  |  | City, State & Zip
Length of Employment |  |  |  |  |  | Length of Employment
Res. Phone |  |  | U.S. Citizen Permanent Resident Other |  |  | Res. Phone |  |  | U.S. Citizen Permanent Resident Other
Bus. Phone |  |  |  |  |  | Bus. Phone
Section 3 - Statement of Financial Condition as of: |  |  |  |  |  |  |  |  |  | 200_
Assets (Do not include assets of doubtful value) |  |  |  | In dollars (omit cents) |  | Liabilities |  |  |  | In dollars (omit cents)
Cash on hand and in this bank |  |  |  |  |  | Notes payable to banks - see [NAME]
Cash in other banks (Bank Certificates of Deposit - see [NAME]) |  |  |  |  |  | Notes payable to other institutions - see [NAME]
U.S. Gov't & marketable securities - see Schedule B |  |  |  |  |  | Due to Brokers
Non - marketable securities - see [NAME] |  |  |  |  |  | Amounts payable to others - secured
Securities held by broker in margin accounts |  |  |  |  |  | Amounts payable to others - unsecured
Restricted, control or margin account stocks |  |  |  |  |  | Accounts and bills due
Real Estate owned - see [NAME] |  |  |  |  |  | Unpaid income tax
Accounts, loans, and notes receivable |  |  |  |  |  | Other unpaid taxes and interest
Automobiles |  |  |  |  |  | Real Estate mortgages payable - see [NAME]
Other personal property |  |  |  |  |  | Other debts (car payments, credit cards, etc.) - itemize
Cash surrender value - life insurance - see Schedule E
Other assets-itemize - see [NAME] if applicable
 |  |  |  |  |  | Total Liabilities
 |  |  |  |  |  | Total Net Worth
Total Assets |  |  |  |  |  | Total Liabilities and Net Worth
PERSONAL INFORMATION |  |  |  | YES | NO | ACCOUNTANT
Do you have a will? |  |  |  |  |  | Name:
If so, name executor: |  |  |  |  |  | Address:
 |  |  |  |  |  | Phone:
Have you ever declared bankruptcy?
If so, describe: |  |  |  |  |  | ATTORNEY
 |  |  |  |  |  | Name:
Have you ever been audited by the IRS? |  |  |  |  |  | Address:
If so, describe: |  |  |  |  |  | Phone:
Section 4-Annual Income For Year Ended |  |  | Annual Expenditures |  |  |  | Contingent Liabilities |  |  |  | Estimated Amounts
Salary |  |  | Mortgage/rental payments |  |  |  | Do you have any… |  | Yes | No
Bonus & commissions |  |  | Real Estate taxes & assessments |  |  |  | Contingent liabilities
Dividends & interest |  |  | Taxes - federal, state & local |  |  |  | Involvement in pending legal actions?
Real Estate income |  |  | Insurance payments |  |  |  | Other special debt or circumstances
Tax Free income |  |  | Other contract payments (car payments, charge cards, etc.) |  |  |  | Contested income tax liens?
Other income |  |  | Alimony, child support, maintenance |  |  |  | If "yes" to any question(s) describe:
(alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.) |  |  | Other expenses
Total Income |  |  | Total Expenditures |  |  |  | Total Contingent Liabilities
([NAME] AND SIGN ON REVERSE SIDE)
SCHEDULE A - CASH AND CERTIFICATE OF DEPOSIT IN OTHER BANKS
Description |  |  | Name of Institution |  |  | In Name of |  |  | Are these Pledged or Held by others? |  | Value
 |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  | 0
SCHEDULE B - U.S. GOVERNMENT & MARKETABLE SECURITIES
Number of Shares or Face Value of Bonds |  | Description |  |  | In Name of |  |  | Are the Registered  Pledged or Held by others? |  | Cost | Market Value
 |  |  |  |  |  |  |  |  |  | 0 | 0
 |  |  |  |  |  |  |  |  |  | 0 | 0
 |  |  |  |  |  |  |  |  |  | 0 | 0
SCHEDULE C - NON - MARKETABLE SECURITIES
Number of Shares | Description |  |  | In Name of |  |  | Are the Registered  Pledged or Held by others? |  | Original Investment | Current Value | Source of Value
 |  |  |  |  |  |  |  |  | 0 | 0
 |  |  |  |  |  |  |  |  | 0 | 0
 |  |  |  |  |  |  |  |  | 0 | 0
SCHEDULE D - RESIDENCE AND OTHER REAL ESTATE (PARTIALLY OR [NAME])
Address and Type of Property |  |  | Title in Name of |  | % of Ownership | Date Acquired | Cost | Market Value | Monthly Payment | Mortgage Balance | Mortgage Maturity
 |  |  |  |  |  |  | 0 | 0 | 0 | 0
 |  |  |  |  |  |  | 0 | 0 | 0 | 0
 |  |  |  |  |  |  | 0 | 0 | 0 | 0
SCHEDULE E - LIFE INSURANCE CARRIED, INCLUDING GROUP INSURANCE
Name of Insurance Company |  | Owner of Policy |  | Beneficiary and Relationship |  | Face Amount |  | Policy Loans |  | Cash Surrender Value
 |  |  |  |  |  | 0 |  | 0 |  | 0
 |  |  |  |  |  | 0 |  | 0 |  | 0
 |  |  |  |  |  | 0 |  | 0 |  | 0
SCHEDULE F - BANK AND OTHER INSTITUTIONAL RELATIONSHIPS
Name and Address of Creditor |  |  | Original Loan / Line Amount |  | Date of Loan | Maturity Date | Unsecured or Secured (List Collateral) |  |  | Monthly Payment | Amount Owed
 |  |  | 0 |  |  |  |  |  |  | 0 | 0
 |  |  | 0 |  |  |  |  |  |  | 0 | 0
 |  |  | 0 |  |  |  |  |  |  | 0 | 0
[NAME] AND OTHER ASSETS
List Name and Address of Any Business Venture in Which You are an Owner, [NAME], or Partner |  |  | Total Assets Listed in Section 3 |  | Your % of Ownership | Your Position / Title in the Business |  | Total Assets of Business | Line of Business |  | Years in Business
 |  |  | 0 |  |  |  |  | 0
 |  |  | 0 |  |  |  |  | 0
 |  |  | 0 |  |  |  |  | 0
SCHEDULE H - INVESTMENT CONSIDERATIONS (COMPLETION OF THIS INFORMATION IS OPTIONAL)
Do you have a brokerage/investment account? |  |  |  |  |  | If yes, with whom?
Approximate market value? |  |  |  |  | 0
Which of the following most accurately reflects your investment objectives? (circle one) |  |  |  |  |  |  |  |  | Growth | Balanced | Income
Do you feel your investments are currently meeting your objectives?
Are you a beneficiary of a retirement plan? |  |  |  |  |  | If yes, what type of plan? |  |  | IRA | Keogh | 401(k)
Approximate Value? |  |  |  |  |  |  |  |  | Company Provided
I/We authorize the Bank to provide this Personal Financial Statement to an affiliate of National Penn Bancshares, Inc.  Utilization of other bank affiliates will not affect your loan request.              __________   (Initials)                   __________   (Initials)
This information contained in this statement is provided to induce you to extend or to continue the extension of credit to the undersigned or to others upon the surety of the undersigned. The undersigned acknowledge and understand that you are relying on the information provided herein in deciding to grant or continue credit or to accept a surety thereof.  Each of the undersigned represents, warrants, and certifies that the information provided herein is true, correct and complete.  Each of the undersigned agrees to notify you immediately and in writing of any change in name, address, or employment and of any material adverse change (1) in any of the information contained in this statement or (2) in the financial condition of any of the undersigned or (3) in the ability of any of the undersigned to perform its (or their) obligations to you.
In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct.  You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein, and to determine the credit-worthiness of the undersigned.  Each of the undersigned authorizes you to answer questions about your credit experience with the undersigned.
 |  |  |  |  |  | Signature (individual)
 |  |  |  |  |  | Social Security Number
Date Signed |  |  |  |  |  | Date of Birth
 |  |  |  |  |  | Signature (other party)
 |  |  |  |  |  | Social Security Number
Date Signed |  |  |  |  |  | Date of Birth
To protect your privacy, this statement should NOT be emailed after it is completed.   You should print this statement, sign and mail it to your Relationship Manager.