Personal Financial Statement of:
Enter your name here
as of:
xx/xx/20xx
Assets Amount in Dollars
Cash - checking accounts $ -
Cash - savings accounts -
Certificates of deposit -
Securities - stocks / bonds / mutual
funds -
Notes & contracts receivable -
Life insurance (cash surrender
value) -
Personal property (autos, jewelry,
etc.) -
Retirement Funds (e.g.. IRAs,
401k) -
Real estate (market value) -
Other assets (specify) -
Other assets (specify) -
Total Assets $ -
Liabilities Amount in Dollars
Current Debt (Credit cards,
Accounts) $ -
Notes payable (describe below) -
Taxes payable -
Real estate mortgages (describe) -
Other liabilities (specify) -
Other liabilities (specify) -
Total Liabilities $ -
Net Worth $ -
Signature: Date:
© Copyright 2013 Docstoc Inc.
Personal Finance Statement of:
Enter your name here
Details
1. ASSETS - Details
Notes and Contracts held
Monthly
From Whom Owing Balance Owing Original Amount Original Date Payment Maturity Date History / Purpose
$ - $ - $ -
Securities: stocks / bonds / mutual funds
Number of Date of
Name of Security Shares Cost Market Value Acquisition
$ - $ -
Stock in Privately Held Companies
Est. Market
Company Name No. of shares $ Invested Value
$ - $ -
Real Estate
Description / Location Market Value Amount Owing Original Cost Purchase Date
$ - $ - $ -
2. LIABILITIES - Details
Credit Card & Charge Card Debt
Name of Card / Creditor Amount Due
$ -
Notes Payable (excluding monthly bills)
Monthly
Name of Creditor Amount Owing Original Amount Payment Interest Rate Secured by (Lien)
$ - $ - $ -
Mortgage / Real Estate Loans Payable
Monthly
Name of Creditor Amount Owing Original Amount Payment Interest Rate Secured by (Lien)
$ - $ - $ -
© Copyright 2013 Docstoc Inc.
- $ -
© Copyright 2011 Docstoc Inc.
$
$ Other Liabilities (Described): $
Personal Property $ $
Other Assets (Describe) $ $
$ Total Liabilities $
Total $ (Total Assets Less Total Liabilities) Net Worth $
Attach additional pages if necessary. Additional pages must be signed and dated by all parties to this financial statement.
ANNUAL INCOME Applicant Co-Applicant PLEASE ANSWER EACH QUESTION (Yes or No)
Salary $ $ Applicant Co-Applicant
Bonuses/Commissions $ $
Are you a co-maker, Endorser, or Guarantor
for any other person's debt or obligation?
Dividends/Interest $ $
Net Real Estate Rental Income $ $ Income Tax Return filed thru what date?
Income from alimony, child support, or Have you ever gone thru Bankruptcy or had a
maintenance payments need not be entered judgment against you in the last 10 years? If
$ $
unless you want it considered as a basis for so, please attach explanation and dates of
repayment. such actions.
Other (list) $ $
Are you a defendant in any suit or legal
action?
Total $ $ Have you made a will?
SCHEDULE 1 / CASH ON HAND AND IN BANKS
Name of Bank or Financial Institution Type of Account Account Balance
$
$
$
Total $
SCHEDULE 2 / SECURITIES OWNED
Description # Shares Par Value Description (Indicate if Listed or Unlisted) Current Market Value
$
$
$
Total
SCHEDULE 3 / LIFE INSURANCE
Face Value of
Insurance Company Cash Value of Policy Insured / Beneficiary Loans
Policy
$
$
Total $
SCHEDULE 4 / RECEIVABLES DUE ME (US) ON NOTES & CONTRACTS I (WE) OWN
Monthly
Name of Debtor Maturity Interest Rate Security Balance Due
Payment
$ $
$ $
$ $
Total
SCHEDULE 5 / REAL ESTATE OWNED