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  • 1. NAVY FEDERAL CREDIT UNION® PO Box 3000 FOR OFFICE USE ONLY Merrifield VA 22119-3000 Telephone: 703-255-8492 or 1-888-503-7106 Date Rec'd _____________ FAX: 703-206-4107 Due Date Loan __________________ PERSONAL FINANCE MANAGEMENT INFORMATION SHEET Visa ___________________ MasterCard ____________ (1) Please complete the following form in detail. (2) Provide a brief explanation of the reasons why you are seeking personal money management assistance. (3) Include all sources of income used to pay expenses shown (part-time jobs, spouse's income, etc). (4) 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 RANK/RATE MEMBER'S NAME (FIRST MI LAST) ACCESS NO. □ Mr. □ Mrs. □ Miss CURRENT ADDRESS TELEPHONE NUMBER (incl. area code) HOME: ( ) DUTY STATION OR EMPLOYER AND ADDRESS (Use abbreviations) OFFICE: ( ) Ext. RELEASE DATE (Military Only) TIME ON JOB DEPENDENTS (ADULTS & MINORS) MEMBER'S DATE OF BIRTH MEMBER'S SOCIAL SECURITY NO. Month Year NUMBER AGES __ __ __ __ □ Indefinite Yrs. Mos. OTHER INCOME NAME OF PERSON & DAYTIME PHONE NO. RELATIONSHIP AGE RESIDING EMPLOYER AND ADDRESS Complete ONLY if relying WITH YOU? on another person's income to repay your obligations. □ Yes □ No TYPE OF AUTOMOBILE(S) OWNED (MAKE MODEL 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*
  • 2. MONTHLY INCOME MEMBER SPOUSE LIVING EXPENSES AMOUNT PER MONTH (Include part-time employment) Mortgage or Rent (principal, interest, tax, Gross or Base Pay ....................... $_____________ $ _____________ insurance, homeowner's/condo fee).......... $ _______________ Utilities (Specify-- gas, oil, coal, electric, Part Time Salary .......................... $_____________ $ _____________ garbage, sewage, water) ............................. $ _______________ Telephone, pager, cellular, internet ........... $ _______________ Quarters Allowance..................... ______________ ______________ Food (for family of ) (household Subsistence or COMRATS .......... ______________ ______________ supplies, cleaning aids, pet costs, dispos- able 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................................ $ _______________ Tobacco Products and Alcohol ................... $ _______________ Other (Explain)............................. ______________ ______________ Auto (gas and oil)......................................... $ _______________ GROSS MONTHLY INCOME....... $_____________ $ _____________ Transportation (other than auto; bus, car pool, taxi)...................................................... $ _______________ PAYROLL DEDUCTIONS Clothing and Shoes ..................................... $ _______________ Federal Taxes............................... $_____________ $ _____________ Dry Cleaning & Laundry .............................. $ _______________ Medical & Dental (prescriptions, glasses, State Taxes .................................. ______________ ______________ aspirin, deductible, copay, etc.) .................. $ _______________ Babysitter/Child or Daycare ........................ $ _______________ Social Security (FICA) ................. ______________ ______________ Entertainment/Recreation (movies, sports, Retirement ................................... ______________ ______________ hobbies, cable T.V., video rental, dining out) ................................................................ $ _______________ Insurance (Explain)...................... ______________ ______________ Personal Needs (haircuts, toiletries, sham- poo, toothpaste, shaving gear .................... $ _______________ Insurance (Explain)...................... ______________ ______________ Miscellaneous (newspaper, charity, allowances Advance Pay stamps, veterinary, storage etc.) Explain....... $ _______________ (Date of Final Deduction) ............ ______________ ______________ SUBTOTAL ................................................... $ _______________ Allotment (Type and Purpose) ... ______________ ______________ Allotment (Type and Purpose) ... ______________ ______________ OTHER EXPENSES Amount per Year (Quarterly, Semi-Annually, Annually) Union Dues .................................. ______________ ______________ Insurance (life, auto, hospital, property).... $ _______________ Other (Explain)............................. ______________ ______________ Taxes (real estate, personal property) ....... $ _______________ Other (Explain)............................. ______________ ______________ Auto Maintenance (repairs, tags and reg- TOTAL PAYROLL DEDUCTIONS $ _____________ $ _____________ istration) ....................................................... $ _______________ NET MONTHLY INCOME (Take House Maintenance (home repairs, yard Home Pay) (Gross Monthly upkeep) ......................................................... $ _______________ Income Minus Total Payroll Deduction).................................... $_____________ $ _____________ Gifts (birthdays, holidays, etc.) ................... $ _______________ COMBINED NET MONTHLY Subscriptions (book clubs, magazines, INCOME (Combined Take record clubs, CD’s)....................................... $ _______________ Home Pay) .................................... $ ____________ Clubs (dues, recreation, health, pool FOR OFFICE USE ONLY fees, associations) ....................................... $ _______________ NET INCOME TOTAL OTHER EXPENSES.......................... $ _______________ $ LIVING EXPENSES MONTHLY AVERAGE OTHER EXPENSES $ (Total Other Expenses divided by 12 mos.) $ _______________ DISPOSABLE INCOME TOTAL EXPENDITURES .............................. $ _______________ $
  • 3. THE FOLLOWING IS A LIST OF MY CURRENT CREDITORS CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL 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!
  • 4. THE FOLLOWING IS A LIST OF MY CURRENT CREDITORS CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ CREDITOR'S NAME CREDITOR'S PHONE NUMBER MONTHLY PAYMENT UNPAID BALANCE $ ADDRESS COLLATERAL DUE DATE LOAN PURPOSE INTEREST RATE ACCOUNT NUMBER WITH CREDITOR AMOUNT PAST DUE $ % $ TOTAL $ $ REMEMBER TO KEEP A COPY OF THIS FORM!
  • 5. NAVY FEDERAL CREDIT UNION® EXTENSION AGREEMENT MEMBER'S NAME (FIRST MI LAST) LOAN NO. DATE (MO., DAY, YR.) MEMBER'S REQUEST AND AGREEMENT (to be completed by the member) __ __ 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 DATE (MO., DAY, YR.) COSIGNER'S AGREEMENT (to be completed by cosigner(s) if applicable) __ __ 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 ACKNOWLEDGEMENT (to be completed by owner(s) other than borrower of DATE (MO., DAY, YR.) __ __ collateral pledged as security for this loan, if applicable) 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 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) *138* © 2005 Navy Federal Credit Union

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