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Financial Statement Disclosure

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Financial Statement Disclosure Information

This financial statement disclosure is for use in connection with a premarital agreement and should be completed accurately and completely. This statement should contain a full disclosure of all your assets and liabilities. You should initial each page and sign the last page. Your prospective spouse should also sign the last page acknowledging receipt.

Both persons must complete a separate financial statement and provide it to the other party. Two forms are enclosed, one for each party.

This form can be completed in Word or printed and completed by hand.

If you require additional space, please attach additional pages for the sections you need to expand.

Financial Statement page - 1 - Initials:

PERSONAL FINANCIAL DISCLOSURE STATEMENT

To: Date:

Individual Information

Name:

Address:

City: State: Zip:

Occupation:

Phone:

Current Assets / Current Liabilities

Current Assets

Cash on Hand or in Banks:

Other Cash:

Real Estate (other than residence Schedule A):

Residence:

Motor Vehicles (Schedule B):

US Government Securities (Schedule C):

Non-Marketable Securities (Schedule D):

Stocks (Schedule E):

Other Personal Property:

Life Insurance Cash Value:

Business IRA:

Notes Receivable:

Other Assets:

Personal IRA:

Antiques:

Partnership Assets:

Total Assets:

Current Liabilities

Notes Payable (Secured) (Schedule F):

Notes Payable (Unsecured) (Schedule G):

Real Estate Mortgages Payable (Schedule H):

Auto Loans (Schedule I):

Unpaid Taxes and Interest:

Due to Brokers:

Open Accounts:

Credit Cards (List):

Visa:

IRA:

Other:

Residential Mortgage:

Total Liabilities:

TOTAL OF ALL ASSETS:

LESS TOTAL OF ALL LIABILITIES:

NET WORTH:

Individual Income Information (Annual)

Salary:

Bonus:

Commissions:

Dividends:

Rental Income:

Other Income (List):

Total Income:

Contingent Liabilities

Guarantor, Co-maker:

Lease or Contracts:

Legal Claims:

Other:

Financial Statement page - 1 - Initials:

Financial Statement page - 2 - Initials:

SCHEDULE “A” REAL ESTATE

Description of Real Estate: Cost: Market Value: Date Acquired:

Totals:

SCHEDULE “B” MOTOR VEHICLES

Description of Motor Vehicles: Cost: Value:

Totals:

SCHEDULE “C” U.S. GOVERNMENT SECURITIES

Description of Stock or Bond: Date Acquired: Par Value: Market Value:

Totals:

SCHEDULE “D” NON MARKETABLE SECURITIES

Description: Date Acquired: Par Value: Market Value:

Totals:

SCHEDULE “E” STOCKS

Company: Shares: Date Acquired: Par Value: Market Value:

Financial Statement page - 2 - Initials:

Financial Statement page - 3 - Initials:

SCHEDULE “F” NOTES PAYABLE SECURED

Description: Date: Balance: Payment (m/yr):

Totals:

SCHEDULE “G” NOTES PAYABLE UNSECURED

Description: Date: Balance: Payment (m/yr):

SCHEDULE “H” REAL ESTATE MORTGAGES

Description: Date: Balance: Payment (m/yr):

Totals:

SCHEDULE “I” AUTO LOANS

Description: Date: Balance: Payment (m/yr):

Totals:

Financial Statement page - 3 - Initials:

Financial Statement page - 4 - Initials:

CERTIFICATION TO FINANCIAL STATEMENT

I certify this Statement to be true and correct as of the date indicated; that this financial statement is a full and fair disclosure of my assets; and that I provided a true and correct copy of this financial statement to on

Signature

Date:

I acknowledge receipt of this financial statement and disclosure.

Signature

Date:

Financial Statement page - 4 - Initials:

Enter text

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

A Financial Statement Disclosure is a documented summary of material financial information provided with financial statements or submitted to lenders, investors, regulators, or counterparties. It combines numeric schedules, narrative notes, certifications, and attachments that explain assumptions, contingencies, related-party items, and accounting policies. Disclosures are commonly required in loan applications, M&A due diligence, compliance reviews, and contract negotiations, and they must be accurate, complete, and dated to the relevant reporting period. Electronic transmission and eSigning are generally accepted under ESIGN and state UETA laws when exceptions do not apply.

Why a Clear Disclosure Matters

A precise, well-organized Financial Statement Disclosure reduces misunderstandings, supports underwriting and audit processes, and limits legal exposure by documenting assumptions and approvals.

Why a Clear Disclosure Matters

Typical Users and Signers

Parties completing the disclosure must coordinate document accuracy, signatory authority, and record retention to meet contractual and regulatory obligations.

  • Lenders and underwriters verifying borrower financial condition for credit decisions and covenant monitoring.
  • Company accountants and controllers preparing consolidated numbers and explanatory notes for third parties.
  • Legal and compliance teams assessing representations, warranties, and regulatory reporting obligations.

Core Elements Found in a Professional Disclosure

A professional Financial Statement Disclosure combines structured financial data with explanatory narrative and signatory attestations so recipients can evaluate the financial position and material uncertainties.

Cover Note

One-page summary stating purpose, reporting period, preparer, and distribution list for quick context.

Balance Sheet

Consolidated assets, liabilities, and equity presented by line item with comparison periods and currency basis.

Income Statement

Revenue, expenses, and net results with year-over-year and quarter-over-quarter variances explained.

Notes & Assumptions

Narrative descriptions of accounting policies, valuation methods, contingencies, and significant estimates.

Certifications

Officer or accountant attestation confirming completeness and accuracy, with signature block and date.

Supporting Schedules

Detailed breakdowns (e.g., receivables aging, debt schedules, related-party transactions) attached as exhibits.

Step-by-Step: Completing a Financial Statement Disclosure

Follow a consistent sequence to collect, verify, and execute disclosure packages to minimize review cycles and legal risk.

  • 01
    Gather Documents: Collect ledgers, bank statements, debt instruments, and prior disclosures.
  • 02
    Populate Fields: Enter figures, narrative notes, and exhibit references carefully.
  • 03
    Internal Review: Have accounting and legal review for accuracy and completeness.
  • 04
    Sign and Distribute: Execute certifications, date the document, and send to recipients.

Setting Up an Online Disclosure Workflow

Configure a digital workflow that enforces routing, authentication, and retention while keeping an audit trail for each step.

Field Configuration
Document Template Prebuild fields and conditional logic for repeated disclosure packages
Routing Order Specify signer sequence: preparer → reviewer → certifying officer
Authentication Choose email, SMS code, or stronger KBA/SSO where required
Auto-reminders Enable scheduled reminders and escalation for unsigned items

Typical eSubmission Flow for a Disclosure Package

An efficient eSubmission workflow reduces manual handoffs and preserves a full audit trail for compliance and audit purposes.

  • Upload: Upload the disclosure PDF or DOCX into the signing platform.
  • Place Fields: Add signature, initial, date, and text fields where required.
  • Send to Signers: Route by role, require authentication, and notify signers by email.
  • Archive: Store signed PDF and certificate of completion in the record repository.

Technical Considerations for eSigning and Storage

Validate that your storage location enforces access controls, versioning, and exportable audit trails for later review.

  • File formats: PDF, DOCX, XLSX supported
  • Integrations: Salesforce, NetSuite, Microsoft 365, Google Workspace
  • Authentication: Email, SMS code, SSO, KBA options

eSignature Vendor Comparison for Financial Disclosures

Compare core pricing and compliance characteristics to select a platform that meets security and volume needs for Financial Statement Disclosures.

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 Varies by plan Varies by plan Varies by plan Varies by plan
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 by plan Varies by plan Varies by plan

Security and Compliance Features to Verify

Encryption in transit: TLS 1.2/1.3
Encryption at rest: AES-256
Audit Trail: Timestamps, IP, events
HIPAA BAA: Available on request
21 CFR Part 11: Supported features available
Certifications: SOC 2, ISO 27001

Consequences of Incorrect or Incomplete Disclosures

Civil Liability: Damages, rescission risk
Regulatory Fines: Agency penalties possible
Contract Default: Remedies and indemnities
Tax Adjustment: Additional tax and penalties
Reputational Harm: Loss of stakeholder trust
Criminal Exposure: Fraud charges in severe cases

Common Preparation Errors to Avoid

  • Inconsistent figures between schedules and main statements that delay underwriting and trigger further documentation requests.
  • Missing supporting exhibits such as debt agreements or bank confirmations that are essential to substantiate liabilities and cash balances.
  • Mismatched names or signatory authority resulting in re-execution requests or rejected submissions by counterparties.
  • Undated or backdated attestations and unsigned certification blocks that render the disclosure non‑compliant with contractual requirements.

Real-World Examples of Digital Disclosures in Use

Organizations across finance, technology, and professional services use electronic disclosures to speed reviews and reduce paper handling.

Optica Ventures, COO

Optica used digital disclosures to streamline investor due diligence and reduce manual delivery.

  • The interface is simple and easy-to-use.
  • As a result, turnaround on financial submissions shortened and external recipients reported fewer questions about format and missing attachments.

Xerox, Director of NetSuite Operations

Xerox automated disclosure packages integrated with ERP export routines to populate schedules.

  • Provides flexibility to get the right signatures.
  • The integration reduced manual reconciliation, ensured consistent formatting, and improved traceability for audits and internal controls.

Frequently Asked Questions About Financial Statement Disclosures

Answers to common questions about legality, execution, correction, and retention of financial statement disclosures.


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