Financial Statement
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FINANCIAL STATEMENT
Name (s)
Address
The following is submitted as being a true and accurate statement of the financial condition of the undersigned on
the ________day of ______________________ 19_____.
ASSETS
LIABILITIES
Applicant
Co-Applicant
Applicant
Co-Applicant
Cash in banks
Notes Payable:
Money markets Funds
To Banks
Contract Deposit
To Relative
Investments: Bonds & Stocks
To Others
-see schedule
Installment Accounts Payable:
Investment in Own Business
Automobile
Accounts and Notes Receivable
Other
Real Estate Owned - see schedule
Other Accounts Payable
Year
Make
Mortgages Payable on Real
Automobiles:
Estate - see schedule
Personal Property & Furniture
Unpaid Real Estate Taxes
Life Insurance
Unpaid Income Taxes
Cash Surrender Value
Chattel Mortgages
Retirement Funds/IRA
Loans on Life Insurance Policies
401K
(Include Premium Advances)
KEOGH
Outstanding Credit Card Loans
Profit Sharing/Pension Plan
Other Debts - itemize
Other Assets
TOTAL LIABILITIES
TOTAL ASSETS
NET WORTH
COMBINED ASSETS
SOURCE OF INCOME
Applicant
Co-Applicant
COMBINED
Base Salary
CONTINGENT LIABILITIES
Overtime Wages
As Endorser or Co-maker on Notes
$
Bonus & Commissions
Alimony Payments (Annual)
$
Dividends and Interest Income
Child Support
$
Real Estate Income (Net)
Are you defendant in any legal action?
Other Income - itemize
Are there any unsatisfied judgments?
TOTAL
Have you ever taken bankruptcy? Explain:
GENERAL INFORMATION
Applicant
Co-Applicant
Personal Bank Accounts at
PROJECTED EXPENSES / MONTHLY
Maintenance
Savings & Loans Accounts at
Apartment Financing
Other Mortgages
Bank Loans
Purpose of Loan
Auto Loan
TOTAL
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Parent category: Financial