Loan Application Checklist, Small Business Loan Intake Form Etc. Page 5
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15OMB APPROVAL NO.: 3245-0188
EXPIRATION DATE: 01/31/2018
PERSONAL FINANCIAL STATEMENT
7(a) / 504 LOANS AND SURETY BONDS
U.S. SMALL BUSINESS ADMINISTRATION
As of ________________, ________
SBA uses the information required by this Form 413 as one of a number of data sources in analyzing the repayment ability and creditworthiness of an application for an
SBA guaranteed 7(a) or 504 loan or a guaranteed surety.
Complete this form for: (1) each proprietor; (2) general partner; (3) managing member of a limited liability company (LLC); (4) each owner of 20% or more of the equity of
the Applicant (including the assets of the owner’s spouse and any minor children); and (5) any person providing a guaranty on the loan
Return completed form to:
For 7(a) loans: the lender processing the application for SBA guaranty
For 504 loans: the Certified Development Company (CDC) processing the application for SBA guaranty
For Surety Bonds: the Surety Company or Agent processing the application for surety bond guaranty
Name
Business Phone
Home Address
Home Phone
City, State, & Zip Code
Business Name of Applicant
(Omit Cents)
(Omit Cents)
ASSETS
LIABILITIES
Cash on Hand & in banks…………………………$ ________________
Accounts Payable……………………………$ ______________
Savings Accounts…………………………………..$ ________________
Notes Payable to Banks and Others……….$ ______________
IRA or Other Retirement Account………………...$ ________________
(Describe in Section 2)
(Describe in Section 5)
Installment Account (Auto)…………………..$ ______________
Accounts & Notes Receivable…………………….$ ________________
Mo. Payments
$ ___________
(Describe in Section 5)
Installment Account (Other)………………....$ ______________
Life Insurance – Cash Surrender Value Only……$ ________________
Mo. Payments
$ ___________
(Describe in Section 8)
Loan(s) Against Life Insurance……………...$ ______________
Stocks and Bonds…………………………………..$ ________________
Mortgages on Real Estate…………………...$ ______________
(Describe in Section 3)
(Describe in Section 4)
Real Estate…………………………………………..$ ________________
Unpaid Taxes………………………………….$ _____________
(Describe in Section 4)
(Describe in Section 6)
Automobiles…………………………………………$ ________________
Other Liabilities………………………………..$ _____________
(Describe in Section 5, and include
(Describe in Section 7)
Year/Make/Model)
Total Liabilities………………………………....$ _____________
Other Personal Property……………………………$ ________________
Net Worth……………………………………….$ _____________
(Describe in Section 5)
Other Assets………………………………………….$ _______________
0
Total
$ _____________
(Describe in Section 5)
*Must equal total in assets column.
0
Total
$ ________________
Section 1.
Source of Income.
Contingent Liabilities
Salary………………………………………………….$ ________________
As Endorser or Co-Maker…………………….$ _____________
Net Investment Income……………………………...$ ________________
Legal Claims & Judgments…………………..$ _____________
Real Estate Income………………………………….$ ________________
Provision for Federal Income Tax…………....$_____________
Other Income (Describe below)*…………………...$ ________________
Other Special Debt…………………………….$ _____________
Description of Other Income in Section 1.
*Alimony or child support payments should not be disclosed in “Other Income” unless it is desired to have such payments counted toward total income.
SBA Form 413 (7a/504/SBG) (09-14) Previous Editions Obsolete
Page 1
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