NAVY FEDERAL CREDIT UNION® PO Box 3000 Merrifield VA 22119-3000 Telephone: 703-255-8492 or 1-888-503-7106 FAX: 703-206-4107
FOR OFFICE USE ONLY Date Rec'd _____________ Due Date Loan __________________ Visa ___________________ MasterCard ____________
PERSONAL FINANCE MANAGEMENT INFORMATION SHEET (1) (2) (3) (4)
Please complete the following form in detail. Provide a brief explanation of the reasons why you are seeking personal money management assistance. Include all sources of income used to pay expenses shown (part-time jobs, spouse's income, etc). Mail the original of this form, together with a copy of a recent statement or pay stub to Navy Federal® at the above address or fax to the number above . (5) KEEP A COPY OF YOUR FILLED-IN PERSONAL FINANCE INFO SHEET. A specialist will telephone you to review it with you and discuss your situation. Optional □ Mr. □ Mrs. □ Miss
RANK/RATE
MEMBER'S NAME (FIRST
MI
LAST)
ACCESS NO.
TELEPHONE NUMBER (incl. area code) HOME:
CURRENT ADDRESS
( DUTY STATION OR EMPLOYER AND ADDRESS (Use abbreviations)
( RELEASE DATE (Military Only) Month Year
□ Indefinite Yrs. OTHER INCOME
DEPENDENTS (ADULTS & MINORS)
TIME ON JOB
NUMBER
MEMBER'S DATE OF BIRTH
AGES
__
Mos.
NAME OF PERSON & DAYTIME PHONE NO.
RELATIONSHIP
Complete ONLY if relying on another person's income to repay your obligations.
TYPE OF AUTOMOBILE(S) OWNED (MAKE
)
OFFICE:
MODEL
AGE
__
)
Ext.
MEMBER'S SOCIAL SECURITY NO. __
__
RESIDING EMPLOYER AND ADDRESS WITH YOU? □ Yes □ No YEAR)
EQUITY IN REAL ESTATE
$ OTHER ASSETS (TYPE AND APPROXIMATE AMOUNT)
CIRCUMSTANCES LEADING TO MY CURRENT FINANCIAL SITUATION ARE:
MEMBER'S SIGNATURE
DATE (MO., DAY, YR.) __
__
NFCU 260 (10-05) Copyright © 2005 Navy Federal
*260*
MONTHLY INCOME
MEMBER
SPOUSE
LIVING EXPENSES
AMOUNT PER MONTH
(Include part-time employment)
Gross or Base Pay ....................... $_____________ $ _____________
Mortgage or Rent (principal, interest, tax, insurance, homeowner's/condo fee).......... $ _______________
Part Time Salary .......................... $_____________ $ _____________
Utilities (Specify-- gas, oil, coal, electric, garbage, sewage, water) ............................. $ _______________
Quarters Allowance..................... ______________ ______________ Subsistence or COMRATS .......... ______________ ______________
Telephone, pager, cellular, internet ........... $ _______________ ) (household Food (for family of supplies, cleaning aids, pet costs, disposable diapers)................................................. $ _______________
Foreign or Sea Pay ...................... ______________ ______________
Food costs away from home (work lunches, vending machines, coffee) .......................... $ _______________
Retirement Pay ............................ ______________ ______________
School Lunches............................................ $ _______________
Child Support/Alimony ............... $_____________ $ _____________
School/Preschool/Other (tuition, books, music/dancing lessons, supplies)............... $ _______________
Clothing Allowance ..................... ______________ ______________
Child Support/Alimony................................ $ _______________
Other (Explain)............................. ______________ ______________
Tobacco Products and Alcohol ................... $ _______________ Auto (gas and oil)......................................... $ _______________
GROSS MONTHLY INCOME....... $_____________ $ _____________ PAYROLL DEDUCTIONS
Transportation (other than auto; bus, car pool, taxi)...................................................... $ _______________ Clothing and Shoes ..................................... $ _______________
Federal Taxes............................... $_____________ $ _____________
Dry Cleaning & Laundry .............................. $ _______________
State Taxes .................................. ______________ ______________
Medical & Dental (prescriptions, glasses, aspirin, deductible, copay, etc.) .................. $ _______________
Social Security (FICA) ................. ______________ ______________ Retirement ................................... ______________ ______________
Babysitter/Child or Daycare ........................ $ _______________ Entertainment/Recreation (movies, sports, hobbies, cable T.V., video rental, dining out) ................................................................ $ _______________
Insurance (Explain)...................... ______________ ______________
Personal Needs (haircuts, toiletries, shampoo, toothpaste, shaving gear .................... $ _______________
Insurance (Explain)...................... ______________ ______________
Miscellaneous (newspaper, charity, allowances stamps, veterinary, storage etc.) Explain....... $ _______________
Advance Pay (Date of Final Deduction) ............ ______________ ______________
SUBTOTAL ................................................... $ _______________
Allotment (Type and Purpose) ... ______________ ______________ Allotment (Type and Purpose) ... ______________ ______________ Union Dues .................................. ______________ ______________ Other (Explain)............................. ______________ ______________ Other (Explain)............................. ______________ ______________ TOTAL PAYROLL DEDUCTIONS $ _____________ $ _____________
OTHER EXPENSES (Quarterly, Semi-Annually, Annually)
Amount per Year
Insurance (life, auto, hospital, property).... $ _______________ Taxes (real estate, personal property) ....... $ _______________ Auto Maintenance (repairs, tags and registration) ....................................................... $ _______________
NET MONTHLY INCOME (Take Home Pay) (Gross Monthly Income Minus Total Payroll Deduction).................................... $_____________ $ _____________
House Maintenance (home repairs, yard upkeep) ......................................................... $ _______________
COMBINED NET MONTHLY INCOME (Combined Take Home Pay) ....................................
Subscriptions (book clubs, magazines, record clubs, CD’s)....................................... $ _______________
FOR OFFICE USE ONLY NET INCOME
$
$ ____________
Gifts (birthdays, holidays, etc.) ................... $ _______________
Clubs (dues, recreation, health, pool fees, associations) ....................................... $ _______________ TOTAL OTHER EXPENSES.......................... $ _______________
$
MONTHLY AVERAGE OTHER EXPENSES (Total Other Expenses divided by 12 mos.) $ _______________
DISPOSABLE INCOME
TOTAL EXPENDITURES .............................. $ _______________
LIVING EXPENSES
$
THE FOLLOWING IS A LIST OF MY CURRENT CREDITORS CREDITOR'S NAME
CREDITOR'S PHONE NUMBER MONTHLY PAYMENT
ADDRESS
COLLATERAL
UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER
ADDRESS
COLLATERAL
MONTHLY PAYMENT
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER MONTHLY PAYMENT
ADDRESS
COLLATERAL
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER
ADDRESS
COLLATERAL
MONTHLY PAYMENT
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER MONTHLY PAYMENT
ADDRESS
COLLATERAL
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER
ADDRESS
COLLATERAL
MONTHLY PAYMENT
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER MONTHLY PAYMENT
ADDRESS
COLLATERAL
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
% SUB TOTAL $
LIST ADDITIONAL CREDITORS ON REVERSE
REMEMBER TO KEEP A COPY OF THIS FORM!
$ $
THE FOLLOWING IS A LIST OF MY CURRENT CREDITORS CREDITOR'S NAME
CREDITOR'S PHONE NUMBER
ADDRESS
COLLATERAL
MONTHLY PAYMENT
UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER
ADDRESS
COLLATERAL
MONTHLY PAYMENT
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER
ADDRESS
COLLATERAL
MONTHLY PAYMENT
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER MONTHLY PAYMENT
ADDRESS
COLLATERAL
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER MONTHLY PAYMENT
ADDRESS
COLLATERAL
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER MONTHLY PAYMENT
ADDRESS
COLLATERAL
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
%
CREDITOR'S NAME
CREDITOR'S PHONE NUMBER
ADDRESS
COLLATERAL
MONTHLY PAYMENT
$ UNPAID BALANCE
$ DUE DATE
LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR
AMOUNT PAST DUE
$
% TOTAL
$
REMEMBER TO KEEP A COPY OF THIS FORM!
$ $
NAVY FEDERAL CREDIT UNION®
EXTENSION AGREEMENT MEMBER'S NAME (FIRST
MI
LAST)
MEMBER'S REQUEST AND AGREEMENT (to be completed by the member)
LOAN NO.
DATE (MO., DAY, YR.) __
__
I request an extension of time to pay off my loan. I understand that if a new payment schedule is approved, Navy Federal Credit Union will return to me a duplicate of this completed agreement showing the new payment schedule. I agree to pay the balance on my loan with interest at the same rate in accordance with the revised payment schedule. I further understand that all other provisions of the original note remain in full force and effect including the accrual of interest. The circumstances necessitating this extension are:
MEMBER'S SIGNATURE
Z COSIGNER'S AGREEMENT (to be completed by cosigner(s) if applicable)
DATE (MO., DAY, YR.) __
__
I agree to this extension of time and/or terms of repayment. I further understand that this extension does not release me from liability towards this debt. SPOUSE/COSIGNER'S SIGNATURE
COSIGNER'S SIGNATURE
Z
Z
ACKNOWLEDGEMENT (to be completed by owner(s) other than borrower of collateral pledged as security for this loan, if applicable)
DATE (MO., DAY, YR.) __
__
Owner(s) of collateral other than borrower acknowledge that the provisions of the original Security Agreement apply to this extension of time and/or terms of repayment.
SIGNATURE OF OWNER OF COLLATERAL OTHER THAN BORROWER
SIGNATURE OF OWNER OF COLLATERAL OTHER THAN BORROWER
Z
Z
FOR OFFICE USE ONLY
CREDIT COMMITTEE ACTION ____________________________________________________ signed a note _______________________ (date of original Promissory Note) in favor of Navy Federal Credit Union in the original amount of $_____________________________, payable $__________________________ per month. In response to the above request the Credit Committee approves: An extension of _________________ months to pay off the unpaid principal balance of $____________________ on this note. Lower monthly payments of $________________________ beginning ________________________. The terms of your loan have been extended to ______________________________. PRESENT DUE DATE (MO., DAY, YR.) __ __ DATE (MO., DAY, YR.) __
LOAN OFFICER CODE
LOAN OFFICER SIGNATURE
__
CREDIT COMMITTEE SIGNATURE
CREDIT COMMITTEE SIGNATURE
NFCU 138 (4-05) © 2005 Navy Federal Credit Union
*138*
