Personal Financial Statement Template

ADVERTISEMENT

PERSONAL FINANCIAL STATEMENT
Dated:
IMPORTANT: Read these directions before completing this Statement
If you are applying for individual credit in your own name and are relying on your own income, or assets and not the income or assets of
another person as the basis for repayment of the credit requested, or if this statement relates to your guaranty of the indebtedness of other
person(s), firm(s), or corporation(s), complete only Section 1, 3 and 4.
If you are applying for individual credit but are relying on income from alimony, child support, or separate maintenance or on the income or
assets of another person as a basis for repayment of the credit requested, complete all Sections. Provide information in Section 2 about the
person whose alimony, support, or maintenance payments or income or assets you are relying on. Alimony, child support, or separate
maintenance income, need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Section 1 – Individual Information (type or print)
Section 2 – Other Party Information (type or print)
Name
Name
Address
Address
City, State & Zip Code
City, State & Zip Code
Social Security #
Date of Birth
Social Security #
Date of Birth
Occupation
Occupation
Business Name
Business Name
Business Address
Business Address
City, State & Zip Code
City, State & Zip Code
Length at current address
Length at current address
Length at employment
Length at employment
Res. Phone
Bus. Phone
Res. Phone
Bus. Phone
Have (either of) you or any firm in which you were a major owner ever declared bankruptcy, or settled any debts for less than the
Yes
No
amounts owed? If yes, please provide details on a separate sheet.
Are (either of) you a defendant in any suit or legal action?
Yes
No
Are (either of) you presently subject to any unsatisfactory judgments to tax liens?
Yes
No
When, if ever, have (either of) you been audited by the IRS?
Section 3 – Statement of Financial Condition as of
Assets
In dollars
If joint,
Liabilities
In dollars
If joint,
(Do not include assets of doubtful
(omit cents)
with
(omit cents)
with
whom
whom
value)
Individual
Joint
Individual
Joint
Cash, Checking & Savings, CD’s – see
Notes payable to banks & others –
Schedule A
see Schedule H
U.S. Gov’t & marketable securities – see
Due to brokers
Schedule B
Non-marketable securities – see
Amounts payable to others-secured
Schedule C
Securities held by broker in margin
Amounts payable to others –
accounts
unsecured
Restricted, control or margin account
Accounts and bills due
stocks
Real estate owned – see Schedule D
Unpaid income tax
Accounts, loans & notes receivable
Other unpaid taxes & interest
Automobiles
Real estate mortgages payable – see
Schedule D & H
Cash surrender value-life insurance-See
Schedule E
Vested interest in deferred compensa-
tion/profit-sharing plan-See Schedule F
Business ventures-see Schedule G
Other Assets/personal property
Total Liabilities
Itemize-see Schedule G if applicable
Net Worth
Total Assets
Total Liabilities & Net Worth

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 3