Can the statement be signed electronically?

Yes. Electronic signatures are enforceable under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted. Ensure intent, consent, attribution, and retention are demonstrable.

Is notarization required for validity?

Not usually for ordinary financial statements, but recipients or state law may require notarization for certain submissions. Check the recipient’s rules and applicable state requirements.

How do I correct an error after signing?

Prepare an amended statement, clearly mark it as amended, include the effective date, and obtain signatures from authorized parties; retain prior versions for audit trails.

What supporting documents should be attached?

Attach invoices, account statements, appraisals, and reconciliations that directly support listed values. Label attachments and reference them by line-item identifier.

Who is authorized to sign the document?

An officer with delegated authority, an authorized manager, or an engaged appraiser should sign. Record the signer’s name, title, and date for verification.

How long must I retain signed statements?

Retention depends on context: at least 3 years for tax-related records (IRC §6501(a)), six years for HIPAA-covered records (45 CFR §164.530(j)), and longer where industry rules require it.

Electronic Signature
Templates
Finance
Financial Statement of Values

Financial Statement of Values

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

FINANCIAL STATEMENT OF VALUES

Identification

Client Name:

Client Address

Contact Phone

Email

Prepared By / Statement Period

Prepared By (Firm or Preparer)

Statement Period — From

Statement Period — To

Summary of Financial Position

Total Declared Assets:

Total Declared Liabilities:

Net Worth (Assets minus Liabilities):

Schedule A — Real Property

Provide all real property held by the reporting party. If none, write "None" and sign below.

Real Property 1 — Description / Parcel

Address / Location

Acquisition Date

Original Cost

Current Market Value

Encumbrance / Mortgage Balance

Insurance Status Insured

Real Property 2 — Description / Parcel

Address / Location

Acquisition Date

Original Cost

Current Market Value

Encumbrance / Mortgage Balance

Insurance Status Insured

Schedule B — Personal Property & Equipment

List major personal property items, equipment, and fixtures. Include inventory totals if applicable.

Item 1 — Description

Acquisition Date

Original Cost

Current Value

Encumbrance

Item 2 — Description

Acquisition Date

Original Cost

Current Value

Encumbrance

Schedule C — Vehicles

Vehicle 1 — Year/Make/Model

VIN

Acquisition Date

Original Cost

Current Value

Lienholder / Creditor

Schedule D — Financial Accounts & Investments

List bank accounts, brokerage accounts, retirement accounts, and other financial assets. Provide most recent balances.

Account 1 — Institution

Account Type

Account Number (Last 4)

Current Balance

Investment 1 — Description

Type

Quantity/Shares

Current Market Value

Schedule E — Liabilities

List all significant debts and liabilities, including creditor, outstanding balance, monthly payment, and maturity.

Liability 1 — Creditor

Outstanding Balance

Monthly Payment

Maturity Date

Supporting Documents

Attach or list documents that substantiate values claimed: appraisals, account statements, title documents, bills of sale, invoices, recent market valuations, and insurance policies. If a document is not available, provide a written explanation below.

Terms, Declarations and Certification

By signing below, the undersigned certifies that the information provided in this Financial Statement of Values is true, complete, and presented in good faith. The undersigned acknowledges that values are estimates where exact figures are not available and that supporting documentation may be requested to verify amounts. The undersigned understands that knowingly making a false statement in this document may subject the signer to civil and criminal penalties under applicable law.

The undersigned authorizes inspection of the listed supporting documents by authorized representatives for the purpose of verification and accepts responsibility for any errors or omissions contained in this statement.

Additional Remarks (optional)

Print Name:

Signature:

Date:

What the Financial Statement of Values Is and When It's Used

A Financial Statement of Values is a formal, itemized record that summarizes an entity's assets, liabilities, and assigned values for a defined reporting period. It consolidates schedules for cash, accounts receivable, inventory, fixed assets, investments, and outstanding obligations and sets out valuation assumptions and methods. Organizations use this document for internal reporting, lending requests, insurance valuation, acquisition due diligence, and regulatory disclosures. The statement supports decisions by providing a single, auditable snapshot of monetary positions and valuation bases tied to specific dates and accounting methods.

Why a Clear Financial Statement of Values Matters

A complete, well-documented Financial Statement of Values ensures consistent valuation across stakeholders, reduces disputes, and supports auditability. Clear values and documented methods improve lender confidence, streamline insurance underwriting, and provide defensible inputs for tax reporting and M&A activity.

Who Typically Prepares and Relies on This Statement

The statement is prepared and used by finance teams, external advisors, and counterparties that need authoritative asset and liability values.

CFOs and controllers who consolidate company valuation inputs for reporting and decision-making.
Lenders and credit officers who evaluate collateral and covenant compliance during credit reviews.
Tax preparers and auditors who use documented values to support tax filings and audit evidence.

When properly completed, it provides a single point of reference for internal governance, external review, and third-party transactions.

Essential Sections to Include in a Professional Statement

Organize the statement into identifiable, labeled sections so reviewers can trace each value to source records and valuation methods in a repeatable way.

Header

Document title, reporting date, preparer name, entity legal name, and contact details to establish document context and point of responsibility.

Valuation Summary

Top-line totals for assets, liabilities, and net value with concise reconciliations to prior periods and an explanation of significant changes or one-time adjustments.

Asset Schedule

Line-item list of asset categories with description, quantity, valuation method, source document references, and per-item values or aggregated totals.

Liability Schedule

Breakdown of payables, loans, deferred liabilities, and contingent obligations showing creditors, balances, interest terms, and maturity or call dates.

Assumptions & Methods

Narrative describing valuation approaches (cost, market, discounted cash flow), key assumptions, discount rates, and any third-party appraisals used.

Certification

Signed and dated certification by an authorized officer or appraiser confirming accuracy, supporting documents attached, and scope limitations or exclusions noted.

Step-by-Step: How to Complete and Finalize the Statement

Follow these sequential steps to prepare, verify, and distribute an auditable Financial Statement of Values.

01

Gather Records: Collect invoices, asset registers, loan statements, and appraisal reports supporting each line item.
02

Calculate Values: Apply the chosen valuation method consistently and document assumptions for each asset category.
03

Populate Form: Enter numbers and references in the prepared fields; attach supporting files and cross-reference schedules.
04

Review & Sign: Have an authorized officer review, sign, and date the statement; store a signed copy in records.

Where to Send and How Submission Works

Routing depends on the intended recipient: internal governance, lender, insurer, or regulatory authority each have preferred delivery channels and documentation expectations.

Internal Filing: Store a signed PDF in the corporate records folder with version control tags.
Lender Submission: Send to the named contact or upload to the lender portal with referenced supporting documents.
Insurance Provider: Provide the statement with valuation backup during underwriting or renewal reviews.
Regulatory Filing: Attach the statement only if specifically required by regulator or disclosure rule.

Configuring an Online Workflow for This Statement

Set up a digital workflow that enforces required fields, attachments, and signer order to reduce manual review and accelerate approvals.

Field Validation	Required fields \| numeric format \| two decimal places
Attachment Rules	Supporting docs required \| PDF or image \| must attach before signing
Signer Order	Preparer → Reviewer → Authorized Signer
Authentication	Email link or SMS code \| optional KBA for higher assurance
Retention Policy	Automatically archive signed PDF \| enforce retention rules

Technology and Format Requirements for eSubmission

Use common file formats and platforms compatible with recipient systems to avoid processing delays or format errors.

File Formats: PDF, DOCX, or exported Excel permitted.
Integration Needs: Connectors to ERP or document storage supported.
Authentication: Email, SMS code, or stronger signer verification.

Typical Timing and Processing Expectations

Timelines depend on recipient requirements and internal review cycles; build buffer time for external verifications and third-party appraisals.

Reporting Period Close:

Prepare statement within 15–30 days after period end for internal review.

Internal Review Due:

Allow 7–14 days for accounting and legal reviews before signature.

Lender Response Window:

Expect 3–10 business days for lender acknowledgement or questions.

Insurance Underwriting:

Underwriting may require 5–30 business days depending on valuation complexity.

Regulatory Submission:

Submit only if specifically requested; agency timelines vary by rule.

Common Mistakes to Avoid When Preparing the Statement

Using inconsistent valuation methods across asset classes without documenting rationale, which creates reconciliation gaps and reviewer objections.
Omitting supporting references or attachments, forcing manual follow-up and delaying approvals from lenders or insurers.
Entering round numbers without decimals or units, increasing the chance of transcription errors during audits or financial consolidation.
Failing to get an authorized signature or not capturing the signer’s title and date, which can render the statement unverifiable for third parties.

Potential Consequences of Inaccurate or Incomplete Statements

Tax Exposure: IRC §6501 and related rules

Regulatory Fines: Agency penalties for false disclosures

Contract Breach: Lender remedies or default triggers

Audit Risk: Increased likelihood of examination

Insurance Denial: Coverage disputes or rescission

Reputational Harm: Loss of stakeholder trust

Typical eSignature Vendor Pricing and Feature Comparison

Compare baseline pricing and common feature distinctions to choose a solution that supports secure signing, audit trails, and required compliance features.

	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	Free trial available	Free trial available	Free trial available	Free trial available
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

Frequently Asked Questions and Practical Answers

Answers to common questions about e-signing, notarization, corrections, storage, and who may sign the Financial Statement of Values.

Need help? Contact support

Can the statement be signed electronically?
Yes. Electronic signatures are enforceable under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted. Ensure intent, consent, attribution, and retention are demonstrable.
Is notarization required for validity?
Not usually for ordinary financial statements, but recipients or state law may require notarization for certain submissions. Check the recipient’s rules and applicable state requirements.
How do I correct an error after signing?
Prepare an amended statement, clearly mark it as amended, include the effective date, and obtain signatures from authorized parties; retain prior versions for audit trails.
What supporting documents should be attached?
Attach invoices, account statements, appraisals, and reconciliations that directly support listed values. Label attachments and reference them by line-item identifier.
Who is authorized to sign the document?
An officer with delegated authority, an authorized manager, or an engaged appraiser should sign. Record the signer’s name, title, and date for verification.
How long must I retain signed statements?
Retention depends on context: at least 3 years for tax-related records (IRC §6501(a)), six years for HIPAA-covered records (45 CFR §164.530(j)), and longer where industry rules require it.

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