Personal Financial Statement - Download as Excel by jeffswanson


Personal Financial Statement in Excel. Great to keep your networth updated for banking relationships.

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									Personal Financial Statement
Type of credit - Mark with an X

Individual - If you mark this space, provide information only about yourself Joint, with Relationship

If you mark this space, provide information about yourself and the other person.

(Note: Any willful misrepresentation could result in a violation of Federal Law (Sec. 18 U.S.C. 1014)) Name: Address: City/State/Zip: Birth Date: # of Dependents: Business/Occupation: Soc. Sec. Num: Home Phone Number: Business Phone: Statement Date:

1 Cash on Hand & in Banks 2 Cash Value of Life Insurance 3 U.S. Government Securities 4 Other Marketable Securities 5 Notes & Accounts Receivable - Good 6 Other Assets Readily Convertible to Cash 7 8 9 10 Total Current Assets 11 Real Estate Owned 12 Mortgages & Contracts Owned 13 Notes & Accounts Receivable - Doubtful 14 Notes Due from Relatives & Friends 15 Other Securities - Not Readily Marketable 16 Personal Property 17 Other Assets 18 19 20 ANNUAL INCOME Salary, Bonuses & Commissions Dividends & Interest Rental & Lease Income (Net) Total Assets $ Sec. II-E Sec. II-F Sec. II-D Sec. II-D Sec. II-C Sec. II-G Itemize $ $ $ $ $ $ $ $ Sec. II-A Sec. II-B Sec. II-C Sec. II-C Sec. II-D Itemize $ $ $ $ $ $


21 Notes Due to Banks 22 Notes Due to Relatives & Friends 23 Notes Due Others 24 Accounts & Bills Payable 25 Unpaid Income Taxes Due 26 Other Unpaid Taxes & Interest 27 Loans on Life Insurance Policies 28 Contract Accounts Payable 29 Cash Rent Owed Sec. II-B Sec. II-H Itemize Sec. II-A Sec. II-H Sec. II-H Sec. II-H $ $ $ $ $ $ $ $ $ $



30 Other Liabilities Due within 1 year 31 32 33 Total Current Liabilities 34 Real Estate Mortgages Payable 35 Liens & Assessments Payable 36 Other Debts 37 38 39 Total Liabilities Net Worth (Assets minus Liabilities) Total Liabilities & Net Worth Estimate of Annual Expenses $0.00 Income Taxes $0.00 Other Taxes $0.00 Insurance Premiums Mortgage Payments Rent Payable Other Expenses:

$ Sec. II-E Itemize $ $ $ Amount $ $


$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00


40 Amount

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation

Other Income - Itemize

If Joint Credit is Checked Above, Other Persons Salary, Bonuses & Commissions
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation

Farm Land Payment



Other Income of Other Person TOTAL General Information Are Any Assets Pledged? (see Section II) Are you a Defendant in any Suits or Legal Actions (Explain) Have you ever been declared Bankrupt in the past 10 years? (Explain)

$ Yes/No TOTAL $ Amount $0.00 $0.00 $0.00 $0.00 $0.00 Contingent Liabilities As an Endorser, Co-maker or Guarantor On Leases or Contracts Legal Claims Federal - State Income Taxes Other:

A. CASH IN BANKS AND NOTES DUE TO BANKS (list all real estate loans in Section II-E) Name of Bank Type of Account Type of Ownership On Deposit $0.00 Notes Due Banks Collateral (if any) & Type of Ownership

Cash on Hand Totals $ (Sec. 1 line 1) B. LIFE INSURANCE (list only those policies that you own) Company Policy Face Value Cash Surrender Value $0.00 Policy Loan from Insurance Company Other Loans with Policy as Collateral Beneficiary $ (Sec. 1 line 21) -

Totals $ (Sec. I line 2)


$ (Sec. I line 27)


C. SECURITIES OWNED (including U.S. Gov't. Bonds and all other Stocks and Bonds)

Personal Financial Statement
Bonds: Face Stock: # shares Description
Indicate those Not Registered in Your Name

Type of ownership


Market Value U.S. Government Securities

Market Value Marketable Sec.

Market Val. Not Readily Marketable Securities

Amount Pledged to Secured Loans

Totals $ (Sec. I line 3)



(Sec. I line 4)

$ (Sec. I line 15) Balance Due Notes Relatives/Friends


D. NOTES AND ACCOUNTS RECEIVABLE (Money payable or owed to you individually - indicated by a X if others have ownership interest) Balance Due Good Balance Due Doubtful Maker/Debtor X When Due Original Amount Accounts Accounts

Security (if any)

Totals $ (Sec. I line 5) E. REAL ESTATE OWNED (indicated by a X if others have ownership interest) Title in the Name Of Date Acquired Present Mkt. Value


$ (Sec. I line 13)


$ (Sec. I line 14)



Description & Location

Original Cost

Amount of Ins. Carried

Mortgage or Contract Payable Balance Due Payment Maturity Payable To

Total $ (Sec. I line 11) F. MORTGAGES AND CONTRACTS OWNED (indicated by a X if others have ownership interest) Cont. Mort.


$ (Sec. I line 34) Starting Date Payment Maturity Balance Due


Maker Name

Maker Address

Property Covered

Total $ G. PERSONAL PROPERTY (indicate by a X if others have ownership interest) Loans on Property Description

(Sec. I line 12)


Date When New

Cost When New

Value Today

Balance Due

To Whom Payable

(Sec. I line 16) H. NOTES (Other than Bank, Mortgage and Insurance Company Loans), ACCOUNTS AND BILLS AND CONTRACTS PAYABLE Other Obligors, if Notes Due to Notes Due Others (Not Payable To any When Due Relatives/Friends Banks) Accounts & Bills Payable

Total $

Contracts Payable

Collateral (if any)

Totals $

(Sec. I line 22)

$ (Sec. I line 23)


$ (Sec. I line 24)


$ (Sec. I line 28)


For the purpose of procuring credit from time to time, I/We furnish the foregoing as a true and accurate statement of my/our financial condition. Authorization is hereby given to the Lender to verify in any manner it deems appropriate any and all items indicated on this statement. The undersigned also agrees to notify the Lender immediately in writing of any significant adverse change in such financial condition.


(Other person, if applicable) Date

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