Form M-433-Ois - Statement Of Financial Condition And Other Information Page 4
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14. List all personal assets. “Furniture or personal effects” includes the current market value of your household assets such as furniture and appliances.
“Other personal assets” includes all artwork, jewelry, collections (coin/gun, etc.), antiques or other assets. Use additional pages if necessary.
a. Furniture or personal effects
Current value
Loan balance
Lender
Monthly payment
Date of final payment
b. Other personal assets
Current value
Loan balance
Lender
Monthly payment
Date of final payment
c. Other personal assets
Current value
Loan balance
Lender
Monthly payment
Date of final payment
d. Other personal assets
Current value
Loan balance
Lender
Monthly payment
Date of final payment
e. Other personal assets
Current value
Loan balance
Lender
Monthly payment
Date of final payment
f. Other personal assets
Current value
Loan balance
Lender
Monthly payment
Date of final payment
15. List all investment assets including stocks, bonds, mutual funds, stock options, certificates of deposit and retirement assets such as IRAs, Keogh and
401(k) plans. Use additional pages if necessary.
a. Name of company
Number of shares or units
Current value
Used as loan collateral? Loan balance
Yes
No
b. Name of company
Number of shares or units
Current value
Used as loan collateral? Loan balance
Yes
No
c. Name of company
Number of shares or units
Current value
Used as loan collateral? Loan balance
Yes
No
d. Name of company
Number of shares or units
Current value
Used as loan collateral? Loan balance
Yes
No
e. Name of company
Number of shares or units
Current value
Used as loan collateral? Loan balance
Yes
No
f. Name of company
Number of shares or units
Current value
Used as loan collateral? Loan balance
Yes
No
16. Do you have life insurance (not term life insurance) with a cash value?
Yes
No
a. Name of insurance company
Policyholder
Policy number
Current cash value
Outstanding loan balance
b. Name of insurance company
Policyholder
Policy number
Current cash value
Outstanding loan balance
c. Name of insurance company
Policyholder
Policy number
Current cash value
Outstanding loan balance
17. List all lines of credit, including credit cards. Provide a copy of a current statement for each account. Use additional pages if necessary.
a. Name of credit institution
Credit limit
Amount owed
Available credit (credit limit less amount owed)
b. Name of credit institution
Credit limit
Amount owed
Available credit (credit limit less amount owed)
c. Name of credit institution
Credit limit
Amount owed
Available credit (credit limit less amount owed)
d. Name of credit institution
Credit limit
Amount owed
Available credit (credit limit less amount owed)
e. Name of credit institution
Credit limit
Amount owed
Available credit (credit limit less amount owed)
f. Name of credit institution
Credit limit
Amount owed
Available credit (credit limit less amount owed)
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