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Personal Financial Statement

Your personal assets, debts and income.

Fill in what applies and leave the rest blank. Include your spouse's assets if they are jointly owned. Your progress saves on this device as you go.

Secure & encrypted ~10 minutes

1Your information

For SBA 7(a)/504 loans this date must be within 120 days of submission.

2Assets (omit cents)

Cash on hand & in banks
$
Savings accounts
$
IRA or other retirement account
Describe in Other details
$
Accounts & notes receivable
Describe in Other details
$
Life insurance — cash surrender value only
Describe in Life insurance
$
Stocks and bonds
$
Real estate
$
Automobiles
Year/make/model in Other details
$
Other personal property
Describe in Other details
$
Other assets
Describe in Other details
$
Total assets$0

3Liabilities (omit cents)

Accounts payable
$
Notes payable to banks and others
$
Installment account (auto)
$
$
Installment account (other)
$
$
Loan(s) against life insurance
$
Mortgages on real estate
$
Unpaid taxes
Describe in Other details
$
Other liabilities
Describe in Other details
$
Total liabilities$0

4Annual income & contingent liabilities

Source of income

Salary
$
Net investment income
$
Real estate income
$
Other income (describe below)
$

Contingent liabilities

As endorser or co-maker
$
Legal claims & judgments
$
Provision for federal income tax
$
Other special debt
$

5Notes payable to banks & others

Personal loans and notes. The total flows into Liabilities automatically.

6Stocks & bonds

7Real estate owned

List each property. Market values and mortgage balances flow into Assets and Liabilities.

8Other details

Retirement accounts, receivables, vehicles (year/make/model), other property. If pledged as security, list the lien holder, lien amount, payment terms and any delinquency.

Type, who it's owed to, when due, amount, and any property a tax lien attaches to.

Describe in detail.

Face amount, cash surrender value, insurance company and beneficiaries.

Assets
$0
Liabilities
$0
Net worth
$0

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