Can I e-sign this statement?

Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. ch. 96) and by UETA in most states, provided the signer shows intent, consents to electronic records, can be attributed, and the record is retained.

Is notarization required?

Not always. Requirements depend on recipient and state law; some courts or lenders require notarization or remote online notarization (RON) where permitted by state rules.

How do I correct an error after submitting?

Notify the requestor immediately and provide a corrected Statement with a dated signature; some recipients require a supplemental affidavit explaining the change.

How is sensitive data protected?

Use platforms with TLS and AES-256 encryption at rest, and confirm HIPAA BAA availability if handling protected health information.

What if I lack supporting documents?

Explain missing items in a cover note and supply replacements as soon as possible; incomplete support often triggers verification requests and delays.

Who can sign on behalf of an entity?

An authorized officer or person with signing authority; attach evidence of authority such as a corporate resolution or power of attorney if requested.

Electronic Signature
Templates
Finance
Financial History Statement

Financial History Statement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

FINANCIAL HISTORY STATEMENT

Client Name: SSN (Last 4): Date Prepared:

Applicant Information

Residential Address Mailing Address (if different)

Primary Phone

Email

Date of Birth

Marital Status

Dependents

Employment and Income

Current Employer Employer Address

Position / Title

Start Date

Gross Monthly Income

Other Monthly Income (describe) Total Monthly Income

Assets

List major assets. Include ownership and current market value.

Description:

Ownership:

Value:

Description:

Ownership:

Value:

Description:

Ownership:

Value:

Description:

Ownership:

Value:

Description:

Ownership:

Value:

Total Asset Value

Liabilities

List all outstanding obligations, including mortgage, auto loans, student loans, credit cards, and other debts.

Creditor:

Type:

Outstanding:

Monthly Pmt:

Creditor:

Type:

Outstanding:

Monthly Pmt:

Creditor:

Type:

Outstanding:

Monthly Pmt:

Total Outstanding Debt

Monthly Expenses

Housing (rent/mortgage) Utilities Food / Groceries

Transportation Insurance (auto, health, other) Childcare / Education

Medical / Other Monthly Expenses (describe) Total Monthly Expenses

Contingent Liabilities and Legal Matters

I have co‑signed or guaranteed loans for others. If yes, provide details below.

I have pending lawsuits, judgments, or legal actions against me. If yes, provide details below.

I have filed for bankruptcy in the past. If yes, indicate year and provide details.

There are tax liens or unresolved tax debts against me. If yes, provide details below.

Credit References

Reference 1

Reference 2

Reference 3

Additional Information / Attachments

List documents attached in support of this statement (pay stubs, bank statements, tax returns, appraisal reports, etc.) and include any additional narrative relevant to financial condition.

Authorization and Certification

I certify under penalty of law that the information contained in this Financial History Statement and any attachments is true, complete and correct to the best of my knowledge. I understand that willful falsification of this statement may subject me to civil or criminal penalties.

I authorize the verification of the information provided herein, including but not limited to obtaining consumer credit reports, employment and income verification, and contacting financial institutions and listed references for the purpose of evaluating my financial condition. This authorization shall remain in effect until revoked in writing.

Consent to credit check: I consent to the obtaining of credit reports and credit history information as necessary for evaluation of this statement.

Disclosure: Certain creditors and institutions will rely on this statement in extending credit or services. I agree to provide updates if my financial condition materially changes prior to final determination by the requesting party.

Applicant:

By:

Date:

What the Financial History Statement Is and When It’s Used

A Financial History Statement is a structured summary of an individual’s or entity’s financial position, including assets, liabilities, income, expenses, credit accounts, and relevant account numbers. Lenders, landlords, courts, immigration officials, and employers use it to assess creditworthiness, financial eligibility, or ability to meet obligations. The document typically requires supporting documentation such as bank statements, pay stubs, tax returns, and proof of liabilities. It can be completed on paper or electronically and often forms part of underwriting, legal filings, or administrative reviews where accuracy and verifiability are essential.

Why a Clear Financial History Statement Matters

A complete, accurate Statement speeds decision-making, reduces follow-up requests, and creates a verifiable record for underwriting, compliance, or legal review. It helps identify issues early and documents disclosures that protect both the submitter and the recipient.

Who Prepares and Reviews These Statements

Typical users range across finance, legal, and administrative roles that need verified financial information.

Borrowers and co-signers completing applications for consumer or commercial credit; used by underwriting teams.
Attorneys, court clerks, and trustees requesting verified financial summaries for litigation, probate, or restructuring.
Employers, immigration officials, and landlords requiring financial disclosure for eligibility or screening decisions.

Knowing the typical reviewers helps you tailor the level of detail and supporting documents you include.

Core Parts of a Professional Financial History Statement

A professional Statement organizes financial data so reviewers can verify current standing and historical trends quickly; include clear headings and labeled exhibits for supporting records.

Asset Listing

Detailed list of cash, bank accounts, investments, real property, vehicles and other tangible or intangible assets with current values and account identifiers where applicable.

Liability Summary

Complete schedule of mortgages, loans, credit card balances, tax liens, judgments and other obligations showing creditor name, balance, monthly payment, and account number where available.

Income Detail

Breakdown of earned and unearned income sources, frequency, gross and net amounts, and year-to-date totals with employer or payer contact information.

Expense Breakdown

Recurring monthly expenses including housing, utilities, insurance, child support, payroll deductions and any other regular obligations that affect cash flow.

Supporting Documents

Attach bank statements, pay stubs, tax returns, credit reports, and payoff statements as labeled exhibits to substantiate amounts declared in the Statement.

Declarations

Signed attestation section where the declarant certifies accuracy, discloses pending claims or suits, and lists any known contingent liabilities.

Essential Data Fields to Include

Full Name: As shown on government ID

Tax Identifier: SSN or ITIN; last four acceptable when requested

Income Summary: Gross and net amounts

Asset Totals: Current estimated values

Liability Totals: Outstanding balances

Signature: Handwritten or e-signed

Step-by-Step: Completing the Statement

Follow these steps to prepare, verify, and submit a complete Financial History Statement.

01

Gather Documents: Collect pay stubs, bank statements, tax returns and payoff letters.
02

Enter Data: Populate each field carefully, following format guidance.
03

Attach Exhibits: Label and upload supporting documents matching line items.
04

Sign and Submit: Sign, date, and send to the requesting organization.

Configuring an Online Completion Workflow

Set up an electronic workflow that guides signers, enforces required fields, and collects supporting files automatically.

Field	Configuration
Required Fields	Make name, signature, and income required
Conditional Fields	Show liabilities only if balances entered
Document Upload	Require PDF attachments for bank statements
Authentication	Email or SMS code verification

Where and How to Send the Completed Statement

After signing, route the Statement to the intended recipient using secure channels appropriate to the recipient’s requirements.

Lender Portal: Upload via lender’s secure document portal per instructions
Court Filing: Submit to the clerk per local e-filing rules
Immigration Office: Follow USCIS or consular submission guidance
Email Delivery: Use encrypted email only if permitted by recipient

Digital Signing and Submission Requirements

Electronic submission needs compatible file formats and authentication to meet recipient policies and legal standards.

File Types: PDF, DOCX supported
Integrations: Salesforce, NetSuite, Microsoft 365
Authentication: Email, SMS, or advanced KBA

Typical Timelines and Response Deadlines

Expect different turnaround times depending on recipient type and whether notarization or additional verification is required.

Response Window:

Requesters commonly allow 7–14 calendar days to return the Statement

Lender Review:

Underwriting typically reviews in 3–10 business days after receipt

Notary Scheduling:

Allow 1–14 days to arrange in-person or remote notarization

Court Deadlines:

Follow the specific filing deadline in the court’s scheduling order

Tax Timing:

Provide documents before tax-filing deadlines when used for tax matters

Common Mistakes That Cause Delays

Submitting inconsistent amounts between form lines and supporting documents, which triggers verification requests and delays.
Missing signatures or dates on key attestations, leading to rejections or requests for re-execution.
Failing to attach required exhibits such as pay stubs or bank statements, increasing processing time significantly.
Providing partial account numbers or P.O. boxes where full addresses or account identifiers are required for verification.

Key Risks and Potential Consequences

Loan Denial: Application may be refused

Civil Liability: Damages or rescission risk

Criminal Exposure: False statements can carry criminal charges

Backup Withholding: 24% withholding for missing TIN

Processing Delays: Additional verification required

Identity Risk: Data exposure increases fraud risk

eSignature Pricing and Feature Comparison

Comparison of starting prices and basic feature availability for common eSignature providers; signNow is listed first per table conventions.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	No	No	Yes, limited	Yes, limited
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Frequently Asked Questions and Troubleshooting

Answers to common questions about e-signing, notarization, corrections, and handling sensitive financial information.

Need help? Contact support

Can I e-sign this statement?
Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. ch. 96) and by UETA in most states, provided the signer shows intent, consents to electronic records, can be attributed, and the record is retained.
Is notarization required?
Not always. Requirements depend on recipient and state law; some courts or lenders require notarization or remote online notarization (RON) where permitted by state rules.
How do I correct an error after submitting?
Notify the requestor immediately and provide a corrected Statement with a dated signature; some recipients require a supplemental affidavit explaining the change.
How is sensitive data protected?
Use platforms with TLS and AES-256 encryption at rest, and confirm HIPAA BAA availability if handling protected health information.
What if I lack supporting documents?
Explain missing items in a cover note and supply replacements as soon as possible; incomplete support often triggers verification requests and delays.
Who can sign on behalf of an entity?
An authorized officer or person with signing authority; attach evidence of authority such as a corporate resolution or power of attorney if requested.

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