Rush & Wynn

							                                              Rush & Wynn
                        PERSONAL ASSET AND LIABILITY STATEMENT
Of
Where assets/liabilities are jointly held please asterisk(*)
Private Dwelling
Address                                                                            Value              £
Lender
Account Number                                    Monthly         £                0/s mortgage       £
                                                  Payment
Cash Resources
Bank/Building                                      Account                         Amount
Society                                            Number
Bank/Building                                      Account                         Amount
Society                                            Number
Stocks and Shares (quoted)
Company                                            Number of                       Value              £
                                                   Shares
Company                                            Number of                       Value              £
                                                   Shares
Life Policies
Company                                            Policy                          Surrender          £
                                                   Number                          Value
Company                                            Policy                          Surrender          £
                                                   Number                          Value
Other Income/Assets




Other Borrowing/Liabilities (including Guarantees)




(Please quote purpose, lender, term and repayments)

We hereby certify that this is a true and accurate record of our assets and liabilities
Signature                                 Date (dd/mm/yy)      Signature                       Date (dd/mm/yy)



If you own any investment properties please complete the separate Property Schedule
Please ensure all properties owned are detailed
For office use only
Total Assets             £                                     Total Liabilities               £
(excluding rent)