RBC ROYAL BANK (CAYMAN) LIMITED
CUSTOMER FINANCIAL STATEMENT AND INFORMATION SHEET
RBC TRANSIT / BRANCH / /DATE (DD-MM-YYYY)
CUSTOMER(S) INFORMATION
CUSTOMER(S) NAME(S)
/
DATE OF BIRTH
MARTIAL STATUS / NUMBER OF DEPENDENTS
SPOUSE’S FULL NAME
CUSTOMER(S) STREET ADDRESS
CITY / TOWN / PARISH
COUNTRY / PHONE NUMBER
YRS/MONTHS AT PRESENT ADDRESS / PREVIOUS ADDRESS IF <2 YRS
EMPLOYER INFORMATION
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
POSITION / LENGTH OF SERVICE / GROSS ANNUAL SALARY
PREVIOUS EMPLOYER’S NAME
PREVIOUS EMPLOYERS ADDRESS
POSITION / LENGTH OF SERVICE / GROSS ANNUAL SALARY
AMOUNT OF OTHER INCOME / SOURCE OF OTHER INCOME
ACCOUNTS AT OTHER BANKS
NAME OF BANK/BRANCH/ACCOUNT #
NAME OF BANK/BRANCH/ACCOUNT #
Assets / Customer Value / Mgr. Value / Liabilities
Current Assets / Current Liabilities
Cash, Deposits, Balances, etc. / Bank Loans – RBC
CSV Life Insurance (exclude loans) / Other Banks
Marketable Securities / Charge Accounts
Accounts & Loans Receivable / Sundry Parties
Other Current #1 / Income Taxes
Other Current #2 / Instalment contracts
Total Current Assets / $ 0.00 / $ 0.00 / Mortgage #1 current portion
Mortgage #2 current portion
Fixed Assets (exclude Household Effects) / Mortgage #3 current portion
Investment in Private Companies / Total Current Liabilities / $ 0.00
Mortgages & Investments
Tax Investments or Pensions / Long Term Liabilities
Automobiles #1 / Deferred Portion – Instalment Contracts
Automobiles #2 / Deferred Portion – Mortgage #1
Real Estate / Deferred Portion – Mortgage #2
Other Fixed #1 / Deferred Portion – Mortgage #3
Other Fixed #2 / Other
Other Fixed #3 / Other
Other Fixed #4 / Total Liabilities / $ 0.00
Other Fixed #5
Is Fire Insurance adequate? / Liabilities as endorser/guarantor (details below)
Total Assets / $ 0.00 / $ 0.00 / Net Worth (N/W @ M/V)
TMTrade-mark of Royal Bank of Canada. RBC and Royal Bank of Canada are registered trade-marks of Royal Bank of Canada. page 1 of 2
/ 11107 CAY (09-2011)RBC ROYAL BANK (CAYMAN) LIMITED
Investments (Life Insurance/Stocks/Bonds/Mtgs, etc.) / Other Assets
Type / Company / Issuer / Debtor / Face Value /
Unit $ / Cash or Market Value / Type / Description / Customer $ Valuation / M/V
Total / $ 0.00 / $ 0.00 / Total / $ 0.00 / $ 0.00
Particulars of Real Estate and Mortgages Owing
Address, Lot size, purpose of buildings, etc. / Current Market Valuation / M/V / Int. Rate / Monthly Payment
(P.I.T) / Amount of Mortgage / Maturity Date
(DD-MM-YYYY) / Owing To / Registered in Name(s) of / Date of Search
(DD-MM-YYYY)
/ / /
/ / /
/ / /
/ / /
Total / $ 0.00 / $ 0.00
Particulars of All Other Liabilities
Owing to / Purpose / Amount / Monthly Payment / Int. Rate / Security (if any)
Total / $ 0.00 / $ 0.00
Particulars of Any Liabilities as Guarantor or Endorser and/or Contingent Liabilities
Name / Details
The information above and on the first page hereof is provided to the bank as a factual statement of my/our affairs. I/We certify that my real estate merchandise, chattels, etc. are entered at fair market valuation and that I/We am/are not being sued.
You may obtain credit information about me/us from my/our employer, any credit bureau or any other person in connection with any of my dealings with you and you may disclose (automatically or upon request) credit information about me/us to credit bureau and to persons with whom I/We have or purpose to have financial dealings where I/We believe disclosure is required by law.
/DATE SIGNED / SIGNATURE OF CUSTOMER / BOTH SIGN IF JOINT STATEMENT
WITNESS NAME / SIGNATURE OF WITNESS / BOTH SIGN IF JOINT STATEMENT
TMTrade-mark of Royal Bank of Canada. RBC and Royal Bank of Canada are registered trade-marks of Royal Bank of Canada. page 1 of 2