Personal Financial Statement Form
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PERSONAL FINANCIAL STATEMENT
As of
,
Complete this form for each applicant. List only those assets you want to be considered in this personal financial statement.
Name
Business Phone
Address
Residence Phone
City, State, & Zip Code
ASSETS
LIABILITIES
(Omit Cents)
(Omit Cents)
$
$
Cash on hand & in Banks
Accounts Payable
$
$
Savings Accounts
Notes Payable to Banks and Others
IRA or Other Retirement Account
$
(Describe in Section 2)
$
Installment Account (Auto)
$
Accounts & Notes Receivable
Life Insurance-Cash Surrender Value Only
$
Mo. Payments
$
(Complete Section 8)
Installment Account (Other)
$
$
Stocks and Bonds
Mo. Payments
$
(Describe in Section 3)
$
Loan on Life Insurance
$
$
Mortgages on Real Estate or Rent listed per month
Real Estate
(Describe in Section 4)
(Describe in Section 4)
$
$
Automobile-Present Value
Unpaid Taxes
$
Other Personal Property
(Describe in Section 6)
(Describe in Section 5)
All other Liabilities such as liens, judgments
$
Other Assets
$
(Describe in Section 7)
$
(Describe in Section 5)
Total Liabilities
$
Net Worth
$
$
Total
Total
Section 1.
Source of Income
Contingent Liabilities
Salary
$
$
As Endorser or Co-signer
Net Investment Income
$
Legal Claims & Judgments
$
Real Estate Income
$
Other contingent liabilities not listed.
$
Other Income (Describe below)*
$
Description of Other Income in Section 1.*
*NOTE: Alimony or child support payments do not need to be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.
List loans, mortgages, credit card accounts, and other indebtedness. (Use attachements if necessary.
Section 2. Loans Payable to Banks and Others.
Each attachment must be identified as a part of this statement and signed.)
Current
Original
Payment
Frequency
How Secured or Endorsed
Name and Address of Noteholder(s)
Balance
Balance
Amount
(monthly,etc.)
Type of Collateral if applicable.
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