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Blank Financial Statement
Personal Financial Statement Form 2
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
Cash on hand & in Banks
Savings Accounts
IRA or Other Retirement Account
Accounts & Notes Receivable
Life Insurance-Cash Surrender Value Only
(Complete Section 8)
Stocks and Bonds
(Describe in Section 3)
Real Estate
(Describe in Section 4)
Automobile-Present Value
Other Personal Property
(Describe in Section 5)
Other Assets
(Describe in Section 5)
Total
Section 1. Source of Income
Salary
Net Investment Income
Real Estate Income
Other Income (Describe below)*
Description of Other Income in Section 1.*
(Omit Cents)
LIABILITIES
(Omit Cents)
$
Accounts Payable
$
$
Notes Payable to Banks and Others
$
$
(Describe in Section 2)
$
Installment Account (Auto)
$
$
Mo. Payments
$
Installment Account (Other)
$
$
Mo. Payments
$
Loan on Life Insurance
$
$
Mortgages on Real Estate or Rent listed per month
$
(Describe in Section 4)
$
Unpaid Taxes
$
$
(Describe in Section 6)
All other Liabilities such as liens, judgments
$
$
(Describe in Section 7)
Total Liabilities
$
Net Worth
$
$
Total
$
Contingent Liabilities
$
As Endorser or Co-signer
$
$
Legal Claims & Judgments
$
$ $
$
Other contingent liabilities not listed.
*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.
Each attachment must be identified as a part of this statement and signed.)
Section 2. Loans Payable to Banks and Others.
Original
Current
Payment
Frequency How Secured or Endorsed
Name and Address of Noteholder(s)
Balance Balance Amount (monthly,etc.)
Type of Collateral if applicable.
Submit by Em ail
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