AFRO Dollar Money — Member Financial Intake Form

👤 Section 1

Personal Information

Tell us about yourself. Fields marked * are required for the FNMA 1003 loan application. Additional fields help us build your complete financial profile.

* Required for FNMA 1003 · + AFRO Extended Field

Borrower Identity

First Name *

Last Name *

Middle Name

Suffix

Date of Birth *

Social Security Number *

Marital Status *

Married Separated Unmarried

Dependents (not listed by co-borrower) *

Ages of Dependents *

Contact Information

Phone Number *

Email Address *

AFRO Master ID *

Current Address

Street Address *

City *

State *

ZIP Code *

Years at Address *

Own or Rent? *

Own Rent No Primary Housing

Race / Ethnicity (For government monitoring purposes — optional)

Ethnicity *

Race *

Sex *

💼 Section 2

Employment & Income

Current and previous employment. Required for loan application.

Current Employer

Employer Name *

Employer Address *

Position / Title *

Years on Job *

Business Phone *

Years in Profession *

Self Employed? *

Yes No

Previous Employment (If less than 2 years at current job)

Previous Employer

From

To

Co-Borrower Employment + AFRO Extended

Co-Borrower Name

Co-Borrower Employer

Co-Borrower Title

Years on Job

💰 Section 3

Monthly Income

All income sources — monthly amounts. This flows directly into your Bill Pay and Personal Financial Statement.

Borrower

$0.00

Co-Borrower

$0.00

Combined Total

$0.00

👤 Borrower Income *

Add all YOUR income sources — salary, gig work, Uber, DoorDash, rental, benefits, side business, cash work — everything.

👥 Co-Borrower Income

Add all CO-BORROWER income sources — spouse, partner, or co-applicant. Leave empty if no co-borrower.

💸 Section 4

Monthly Expenses

Add all your monthly expenses. Pre-loaded categories are a starting point — add your own categories and items. Delete anything that does not apply. Fields marked * are required for the FNMA 1003.

Total Monthly Expenses

$0.00

🏦 Section 5

Assets

All assets — bank accounts, investments, property, vehicles. Flows to your Wealth Portal and Balance Sheet.

Bank Accounts *

Add an Asset Section

You can add up to 4 sections at a time. Each section expands to show the full form.

Real Estate & Properties + AFRO Extended

Add all properties — primary home, rental properties, land, vacation home, commercial.

Vehicles + AFRO Extended

Add all vehicles — cars, trucks, motorcycles, boats, RVs, planes.

💳 Section 6

Liabilities & Debt

All debts and monthly obligations. Flows to your Debt Portal. Fields marked * are required for the 1003.

Credit Cards & Revolving Debt *

Installment Loans *

Personal Debts + AFRO Extended

Other Obligations + AFRO Extended

Medical Debt

Tax Debt Owed

Child Support / Alimony Owed *

Other Monthly Obligations *

📥 Section 7

Accounts Receivable + AFRO Extended

Money owed TO you by others — individuals, businesses, settlements. This goes to your Accounts Receivable portal. Not on the standard 1003 but important for your complete financial picture.

Personal Credits Owed to Me

Business Receivables

Outstanding Invoices

Expected Settlements

Expected Inheritances / Trusts

🏠 Section 8

Real Estate & Loan Purpose

Property information for loan application. Required for FNMA 1003.

Loan Purpose *

Purpose of Loan *

Property Type *

Loan Amount *

Purchase Price *

Property Address *

Property Street Address *

City *

State *

ZIP Code *

Number of Units *

Describe Improvements / Intended Use

Current Homeownership Status + AFRO Extended

Current Status

Down Payment Saved

Down Payment Goal

🛡️ Section 9

Insurance & Tax Profile + AFRO Extended

Complete insurance inventory and tax profile. Flows to Insurance and Tax portals.

Insurance Policies

Health Insurance Provider

Monthly Premium

Life Insurance Provider

Monthly Premium

Home / Renters Insurance

Monthly Premium

Auto Insurance Provider

Monthly Premium

Tax Profile

Federal Tax Filing Status

Last Year Gross Income

Federal Tax Paid Last Year

State Tax Paid Last Year

Annual Property Tax

Self-Employment Tax

📋 Section 10

Declarations *

Required declarations for the FNMA 1003 loan application. Answer all questions honestly.

Legal & Financial Declarations *

Acknowledgment & Signature *

By submitting this form I certify that the information provided is true and correct as of the date submitted. I understand that any intentional or negligent misrepresentation may result in civil liability. I authorize AFRO Dollar Money Inc. to verify the information provided and to obtain a credit report.

Full Legal Name (as signature) *

Date *

I have read and agree to the terms above. I certify all information is accurate and complete.

I authorize AFRO Dollar Money to obtain credit reports and verify all financial information provided.

I authorize my intake information to be used to pre-populate my AFRO Dollar Money portal accounts.