Loan Application

Step 1 of 3

Personal History & Resume

One copy of this form needs to be completed by individuals who own 20% or more of the Operating Company and/or Real Estate Holding Company.

Full Legal Name:(Required)

Date of Birth:(Required)

Social Security Number:(Required)

Home Street Address:(Required)

City State / Province / Region ZIP / Postal Code

Time at Residence:(Required)

Home Phone:(Required)

Business Phone:(Required)

Email:(Required)

Previous Address

City State / Province / Region ZIP / Postal Code

Time at Residence:(Required)

Spouse's Name:(Required)

Social Security Number:(Required)

Marital Status(Required)

No. of Children:

Government Questions

The following information is requested by the Federal Government in order to monitor compliance with Federal Law. You are not required to provide it, but are encouraged to do so. This information will not be used to evaluate your application or to discriminate against you in any way. SICOG is an Equal Opportunity Lender

Race:(Required)

Ethnicity:(Required)

Gender:(Required)

Are you employed by the U.S. Government(Required)

If yes, please provide the name of the agency and your position:

Branch of Military:(Required)

Rank at Discharge:(Required)

Job Desciption:(Required)

Dates of Service(Required)

Honorable(Required)

Are you currently under indictment, on parole or probation? If yes, indicate the date that parole or probation is to expire:(Required)

Have you ever been charged with and or arrested for any criminal offense other than a minor motor vehicle violation? Include offenses which have been dismissed, discharged, or not prosecuted (all arrests and charges must be disclosed and explained on an attached, signed sheet).(Required)

Have you ever been convicted, placed on pretrial diversion, or placed on any form of probation, including adjudication withheld pending probation, for any criminal offense orther than a minor vehicle violation?(Required)

Education

College or Training Institution

Dates Attended

________ to ________

Major

Degree

Work Experience

List chronologically, beginning with present employment

Name of Company:(Required)

Ownership Percentage:(Required)

Full Address:(Required)

Date(Required)

Title:(Required)

Duties:(Required)

Disclosure & Signature

To the best of my/our knowledge, the information contained in this application is true and accurate. I/we have not paid anyone for help in preparing this application, nor have we relied on SICOG for the information contained therein. There is no direct or indirect conflict of interest between me/us and SICOG. This application authorizes SICOG and its affiliates to verify any and all of the information contained herein, and to check and and all of my/our credit, wherever it may be.

Date

Name of Borrower

Signature(Required)