Personal Financial Statement Template
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1
2PERSONAL FINANCIAL STATEMENT
As of _________________________
Complete this form for any person providing a guaranty on the loan.
Business Phone:
Name:
Residence Address:
Residence Phone:
City, State & Zip Code
Date of Birth:
Business Name of Applicant / Borrower:
ASSETS
LIABILITIES
Cash on Hand & in Banks
$
Accounts Payable
$
Savings Accounts
$
Notes Payable to Bank and Others
$
(Describe in Section 2)
IRA or Other Retirement Accounts
$
Installment Accounts (Auto)
Accounts & Notes Receivables
$
$
Life Insurance-Cash Surrender Value Only
$
Installment Accounts (Other)
(Complete Section 8)
$
Stocks & Bonds
$
Loan on Life Insurance
(Describe in Section 3)
$
Real Estate
$
Mortgages on 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)
Other Liabilities
Other Assets
$
$
(Describe in Section 7)
(Describe in Section 5)
Total Liabilities
$
Total Assets
$
$
Net Worth
Section 1. Source of Income:
Contingent Liabilities:
Salary
$
As Endorser or Co-Maker
$
Net Investment Income
$
Legal Claims & Judgments
$
Real Estate Income
$
Federal Income Tax
$
Other Income
Other Debt
$
$
(Describe below)
Description of Other Income in Section 1.
Section 2. Amounts Owed to Creditors.
(Use attachments if necessary. Each attachment must be identified as a part of this statement and signed)
Original
Current
Payment
Secured, and if so Type
Frequency
Name and Address of Creditor(s)
Balance
Balance
Amount
of Collateral
(monthly, etc.)
Secured/Unsecured
Secured/Unsecured
Secured/Unsecured
1
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