Can this form be signed electronically?

Yes. Electronic signatures are generally legally enforceable under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and reliable record retention are satisfied; exceptions (wills, certain court filings) still require paper in many jurisdictions.

Does an eSignature meet evidentiary needs?

A robust audit trail showing signer identity, timestamp, and actions supports attribution; stronger authentication or digital signatures may be required for regulated records depending on recipient or industry standards.

Is notarization required for the statement?

Not typically for all transactions, but specific recipients or state laws may require a notarized affidavit or acknowledgment; check the recipient’s requirements and state notary law before submission.

How do I correct a signed statement?

Prepare an amended statement clearly labeled as an amendment with the effective date, reference the original, and obtain fresh signatures; avoid handwritten changes on a signed original which can raise authenticity issues.

What documentation should accompany the statement?

Attach creditor statements, promissory notes, loan agreements, payoff quotes, and any security instruments cited, so reviewers can verify balances and terms without separate requests.

How long should I keep signed copies?

Retain for at least the active term plus applicable retention periods: IRS records generally 3 years (IRC §6501(a)), HIPAA-related documents 6 years (45 CFR §164.530(j)), and longer where state law or industry rules require it.

Electronic Signature
Templates
Finance
Financial Statement of Liabilities

Financial Statement of Liabilities

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

FINANCIAL STATEMENT OF LIABILITIES

Client Name: Primary Contact Telephone:

Current Address

Social Security Number or Tax ID

Reporting Date

ENTITY TYPE

Individual Corporation Partnership Trust

INSTRUCTIONS AND CERTIFICATION

Complete this Financial Statement of Liabilities to disclose all material obligations and contingent liabilities as of the Reporting Date. The undersigned certifies under penalty of law that the information provided in this statement is true, complete and correct to the best of the undersigned’s knowledge and belief. Willful misstatement or omission of material facts may subject the signer to civil or criminal penalties.

Authorization is granted to verify credit and employment information and to obtain payment and balance information from listed creditors. This statement is a continuing statement and must be amended promptly if circumstances materially change prior to the resolution of the matter for which this statement is provided.

SCHEDULE A — SECURED LIABILITIES

List all secured obligations (mortgages, vehicle loans, equipment loans, secured lines of credit).

Creditor	Account No.	Original Amount	Current Balance	Monthly Payment	Collateral / Security	Maturity Date

SCHEDULE B — UNSECURED LIABILITIES

List all unsecured obligations (credit cards, personal loans, medical debts, judgments).

Creditor	Account No.	Current Balance	Monthly Payment	Status / Notes

SCHEDULE C — CONTINGENT, CO-SIGNED AND OTHER LIABILITIES

Include guarantees, co-signed obligations, pending suits, tax liens, letters of credit, and any other material contingent liabilities.

AGGREGATE LIABILITIES

Total Secured Liabilities

Total Unsecured Liabilities

Total Contingent / Other Liabilities

Grand Total Liabilities

NOTES, ATTACHMENTS AND TERMS

Attach copies of promissory notes, loan agreements, security agreements, judgments, and any supporting documentation for listed liabilities. Provide explanations below for any entries that require additional detail.

DECLARATION AND SIGNATURE

By signing below, the undersigned declares that the information in this Financial Statement of Liabilities is true and complete. The undersigned authorizes verification of any information provided and acknowledges that this statement may be relied upon in connection with credit decisions, legal proceedings, or other financial determinations.

Signature

Printed Name:

Signature:

Date:

Title / Relationship to Entity (if applicable):

What a Financial Statement of Liabilities Is and when it’s used

A Financial Statement of Liabilities is a formal record that lists an individual’s or entity’s outstanding debts, obligations, and contingent liabilities at a point in time. It consolidates creditor names, outstanding balances, collateral descriptions, payment terms, and relevant account numbers for lenders, trustees, counsel, or internal review. Organizations use it for loan underwriting, bankruptcy schedules, asset transfers, due diligence during mergers, and internal financial controls. Accuracy is essential because the statement supports legal, tax, and credit decisions and may be relied on by third parties.

Why maintaining a clear liabilities statement matters

A concise Financial Statement of Liabilities improves transparency for lenders, legal reviewers, and auditors, speeds underwriting and due diligence, and reduces disputes by documenting amounts, terms, and supporting evidence in one place.

Typical users and stakeholders for this statement

The Financial Statement of Liabilities is completed by and shared among several roles depending on context.

Lenders and underwriters reviewing credit exposure and collateral during loan approval.
Accountants and auditors validating balances and reconciling financial records for reporting.
Trustees, bankruptcy counsel, or corporate counsel preparing schedules and legal disclosures.

Roles may vary by use case: in bankruptcy the debtor files schedules, while in a loan closing the borrower provides the statement to the lender.

Step-by-step: preparing and submitting a complete statement

Follow these steps to compile, verify, and deliver a Financial Statement of Liabilities with supporting documentation.

01

Gather records: Collect creditor statements, loan agreements, and account ledgers.
02

List liabilities: Enter each obligation with creditor, balance, and date as separate line items.
03

Attach proof: Attach statements, promissory notes, or bills supporting each balance.
04

Review and sign: Have authorized signatory confirm accuracy, sign, and date the statement.

Essential components of a professional Financial Statement of Liabilities

A complete form groups high-level totals with line-item schedules, supporting evidence, and a signed certification of accuracy.

Summary Totals

A top-line section showing total secured liabilities, unsecured liabilities, and contingent obligations, allowing reviewers to assess exposure quickly without parsing every line item.

Detailed Schedule

A table listing each creditor, account number, outstanding balance, payment terms, maturity date, and collateral description so each obligation can be traced to source documents.

Payment Terms

Clear indication of interest rate, next payment date, payment frequency, and any balloon payments or default provisions that affect cash-flow and risk evaluation.

Collateral and Priority

Describe pledged assets, lien priority, and whether the creditor holds a perfected security interest; include recording references when applicable.

Supporting Documents

Attach account statements, promissory notes, security agreements, or court filings for each liability to substantiate balances and terms.

Certification

A signer’s statement attesting to the accuracy of the information, dated and signed by an authorized person, to support legal reliance.

Core data elements required on the form

Debtor identity: Full legal name

Creditor identity: Official creditor name

Liability type: Secured or unsecured

Current balance: USD amount and date

Collateral info: Asset description if secured

Supporting docs: Statements, agreements attached

How to configure this form for online completion

Configure fields, authentication, and storage to match your compliance and audit requirements before sending the document for signature.

Field	Configuration
Signature Field	Required; date stamp enabled
Authentication	Email + SMS code recommended
Template Name	Financial Statement of Liabilities
Storage	PDF/A archival with audit trail

Technical considerations for digital completion and e‑submission

Choose a platform that supports PDF/Word import, audit trails, and the signer authentication level required by your process.

File formats: PDF and DOCX supported
Authentication: Email, SMS, or KBA
Integrations: CRMs and cloud storage

Confirm the platform provides tamper-evident signed PDFs and an accessible audit trail to document intent, attribution, and consent for legal validity.

Where to send or file the completed statement

The destination depends on context: lender underwriting, court or trustee submission, buyer/seller due diligence, or internal records management.

Lender delivery: Send to the loan officer or underwriting portal specified by lender
Court or trustee: File as required by court or bankruptcy trustee procedures
Transaction counterparties: Provide to buyer, escrow, or closing agent for M&A or real estate closings
Internal records: Store in document management system with retention policy

Typical timing expectations and important dates

Timing varies by use: supply the statement when requested for underwriting, attach to filings by court deadlines, or provide at closing as required by transaction terms.

On request:

Provide immediately when a creditor or lender requests supporting documentation

Loan underwriting:

Submit with application per lender deadline before conditional approval

Bankruptcy schedules:

File according to bankruptcy court filing schedule

Closing date:

Deliver updated statement at or before closing as required

Periodic updates:

Refresh for major changes or material increases in liabilities

Key milestones from preparation to final filing

Track these sequential stages to ensure completeness and timely submission of the statement.

01

Prepare records

Collect account statements, agreements, and payoff figures.

02

Draft schedule

Compile line items and supporting attachments.

03

Internal review

Have accounting or legal team verify accuracy.

04

Submit and archive

Send to recipient and save signed copy with audit trail.

Common mistakes to avoid when preparing the statement

Omitting creditors or splitting a single obligation across multiple entries, which creates reconciliation inconsistencies and creditor disputes.
Using outdated balance dates without noting the date of the reported balance, which can misstate current exposure during underwriting.
Providing informal descriptions instead of account numbers or legal creditor names, making automated matching and verification difficult.
Failing to attach supporting documents (statements, promissory notes), which prolongs review and may trigger additional validation requests.

Legal and financial risks from incorrect or missing information

Contract breach: May trigger default or remedies

Tax exposure: Incorrect reporting can affect tax obligations

Loan denial: Underwriters may decline credit

Bankruptcy risk: Omitted liabilities can complicate proceedings

Perjury exposure: False statements to courts carry sanctions

Statute impact: Affects limitation and pursuit of claims

eSignature vendor comparison for signing and managing the Financial Statement of Liabilities

Comparison of common eSignature vendors for secure signing, audit trails, and HIPAA or enterprise compliance. signNow is listed first per vendor ordering rules.

	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	Varies	Varies

Real-world examples: how organizations used a liabilities statement

These short cases illustrate typical uses and operational impact when statements are accurate and well-documented.

Optica Ventures — operational reporting

Optica Ventures improved investor reporting by consolidating liabilities into a single statement with attachments.

The interface was simple for internal teams to use.
The consolidated statement reduced back-and-forth with investors by centralizing balances and supporting notes into one authoritative record that sped funding decisions and reduced clarification requests.

Fertility Centers of Illinois — compliance and signatures

The clinic standardized liability reporting for corporate accounts and vendor payment terms.

The team cited strong API integrations.
Standardized statements integrated with existing ERPs reduced reconciliation time and ensured signed copies with audit trails were archived for compliance and future audits.

Who can sign and certify the statement

Authorized Officer — CFO

The chief financial officer or equivalent officer typically has authority to certify corporate liabilities, attest to accuracy, and sign on behalf of the organization in contract and credit contexts.

Authorized Agent — Attorney

An attorney-in-fact or designated signatory under a power of attorney may sign if properly authorized; attach documentation showing the grant of authority to avoid disputes.

Frequently asked questions about the Financial Statement of Liabilities

Answers to common questions about legal validity, eSigning, notarization, corrections, and recordkeeping for liabilities statements.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures are generally legally enforceable under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and reliable record retention are satisfied; exceptions (wills, certain court filings) still require paper in many jurisdictions.
Does an eSignature meet evidentiary needs?
A robust audit trail showing signer identity, timestamp, and actions supports attribution; stronger authentication or digital signatures may be required for regulated records depending on recipient or industry standards.
Is notarization required for the statement?
Not typically for all transactions, but specific recipients or state laws may require a notarized affidavit or acknowledgment; check the recipient’s requirements and state notary law before submission.
How do I correct a signed statement?
Prepare an amended statement clearly labeled as an amendment with the effective date, reference the original, and obtain fresh signatures; avoid handwritten changes on a signed original which can raise authenticity issues.
What documentation should accompany the statement?
Attach creditor statements, promissory notes, loan agreements, payoff quotes, and any security instruments cited, so reviewers can verify balances and terms without separate requests.
How long should I keep signed copies?
Retain for at least the active term plus applicable retention periods: IRS records generally 3 years (IRC §6501(a)), HIPAA-related documents 6 years (45 CFR §164.530(j)), and longer where state law or industry rules require it.

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