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Side by Side: A Guide to Fair Lending

APPENDIX A: TESTER IDENTITY

Personal Information:

Name:_____________________________________________________________________ Race:_____________________ Age:_____________________ Sex:_____________________

Current

Address: ___________________________________________________________________

Marital Status:______________________________ How Long:_____________________

Spouse's Name:____________________________ Age:__________________________

Number of Children:__________________________

Names/Ages: _______________________________________________________________

Years at Current Address: _____________________________________________________

Rent Amount: _______________________________________________________________

Previous Address: ___________________________________________________________

Years at Previous Address: ____________________________________________________

Rent Amount: _______________________________________________________________

Employment Information:

Employer: _________________________________________________________________

Occupation: ________________________________________________________________

Address of Employer:_________________________________________________________ __________________________________________________________________________

Length of Employment: _______________________________________________________

Monthly Gross Income: _______________________________________________________

Annual Gross Income ________________________________________________________

Monthly Net Income: _________________________________________________________

Previous Employer: __________________________________________________________

Occupation: ________________________________________________________________

Length of Employment: _______________________________________________________

Monthly Gross Income: _______________________________________________________

Annual Gross Income: ________________________________________________________

Monthly Net Income: _________________________________________________________

Spouse's Employer: __________________________________________________________

Occupation: ________________________________________________________________

Length of Employment: _______________________________________________________

Monthly Gross Income: _______________________________________________________

Annual Gross Income: ________________________________________________________

Monthly Net Income: _________________________________________________________

Spouse's Previous Employer: __________________________________________________

Occupation: ________________________________________________________________

Length of Employment: _______________________________________________________

Monthly Gross Income: _______________________________________________________

Annual Gross Income: ________________________________________________________

Monthly Net Income: _________________________________________________________

Total Annual Household Income:______________

Gross:___________________________________

Net:_____________________________________

Credit Information:

Charge Card(s): Balance Monthly Payment

(1)______________________ ______________________ ______________________

(2)______________________ ______________________ ______________________

(3)______________________ ______________________ ______________________

Loan(s): Balance Monthly Payment

(1)______________________ ______________________ ______________________

(2)______________________ ______________________ ______________________

(3)______________________ ______________________ ______________________

Other Financial Information:

Savings: ___________________________________________________________________

Amount: ___________________________________________________________________

Checking: __________________________________________________________________

Amount: ___________________________________________________________________

Other: _____________________________________________________________________

Housing Information:

Neighborhood/House Location__________________________________________________

Address: ___________________________________________________________________

Size/# Bedrooms: ____________________________________________________________

Style: _____________________________________________________________________

Age:___________ CAC:___________ Garage Type:___________ Taxes:___________

Sales Price: ________________________________________________________________

Closing Date: _______________________________________________________________

Down payment: _____________________________________________________________

Source: ____________________________________________________________________

Other closing costs: __________________________________________________________

Source: ____________________________________________________________________

Information about the Financial Institution:

Name:_____________________________________________________________________

Address: ___________________________________________________________________

Phone: ____________________________________________________________________

Hours:_____________________________________________________________________

How you found this office: _____________________________________________________

Miscellaneous:

 

Other Instructions: ________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

Last Updated 07/28/1999 supervision@fdic.gov