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Personal Financial Statement Form

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PERSONAL FINANCIAL STATEMENT

Client Name:    Social Security No.:

PERSONAL INFORMATION

Phone:

Email:

Date of Birth:

Occupation / Employer:

Marital Status:

STATEMENT DATE

Statement As Of:

ASSETS (CURRENT MARKET VALUE)

All amounts must be stated in U.S. dollars. Round to the nearest dollar. Include only your ownership interest; indicate lien amounts where applicable.

Cash on hand and in banks: $

Marketable securities (attach schedule): $

Accounts receivable: $

Life insurance — cash surrender value: $

Automobiles (list make/model/year): $

Total Assets: $

LIABILITIES (CURRENT BALANCES)

Accounts payable: $

Notes payable to banks: $

Notes payable to others (family/friends): $

Vehicle loans: $

Student loans: $

Total Liabilities: $

Net Worth (Total Assets minus Total Liabilities): $

INCOME AND EXPENSES (ANNUAL)

Salary/wages: $

Bonuses/commissions: $

Investment income/dividends: $

Rental income: $

Total Annual Income: $

CONTINGENT LIABILITIES AND DISCLOSURES

Are you a guarantor, co-maker, or endorser for any obligation?

Any pending lawsuits, judgments, tax liens, or bankruptcy filings?

SCHEDULES (ATTACH AS NEEDED)

CERTIFICATION, AUTHORIZATION, AND WARRANTIES

I certify that the foregoing statements are true, complete and correct to the best of my knowledge and belief and are provided for the purpose of inducing the recipient to extend credit or other financial accommodations. I understand that material misstatements or omissions may constitute an act of fraud and may be grounds for denial of credit or other remedies available at law or equity.

I authorize the recipient to verify information contained herein, to obtain credit reports and employment verification, and to disclose this statement and supporting information to third parties where permitted by law, for the purpose of evaluating creditworthiness or in connection with collection or enforcement of any resulting obligation. This authorization shall be continuing while any obligation remains unpaid or contingent liabilities exist.

I agree to notify the recipient in writing within thirty (30) days of any material adverse change in my financial condition. I warrant that there are no material misstatements or omissions in this statement and that I have disclosed all liabilities, contingent obligations, and claims known to me.

Signature

Print Name:

Signature:

Date:

Title/Relationship (if applicable):

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What the Personal Financial Statement Form Is and When It’s Used

A Personal Financial Statement Form is a structured record that summarizes an individual’s financial position at a given date, listing assets, liabilities, income, and contingent obligations. Lenders, landlords, courts, and financial advisers commonly request it to evaluate creditworthiness, underwriting risk, or eligibility for loans and leases. The form consolidates supporting figures such as bank balances, investment values, real property equity, outstanding loans, and guarantees. Completed accurately, it establishes a baseline for decisions that depend on personal solvency and can be required as part of loan origination, refinancing, or legal proceedings.

Why a Complete Personal Financial Statement Matters

Providing a clear, current Personal Financial Statement reduces underwriting delays and supports accurate credit decisions. It helps counterparties assess risk, set collateral terms, and determine lending capacity while creating a single reference for income and asset verification.

Why a Complete Personal Financial Statement Matters

Who Commonly Prepares and Reviews These Forms

The Personal Financial Statement is used by a range of professionals and private individuals across lending, real estate, and legal contexts.

  • Borrowers and loan applicants who need to document assets, liabilities, and income for a lender or guarantor.
  • Private lenders, banks, and mortgage brokers assessing collateral and debt-to-income ratios during underwriting.
  • CPAs, attorneys, and trustees who rely on a consolidated financial snapshot for estate planning, divorce, or litigation support.

Forms should be updated whenever financial circumstances change materially or when a new lender or legal proceeding requests current information.

Core Sections a Professional Personal Financial Statement Should Include

A well-structured Personal Financial Statement presents identifying information, a detailed asset schedule, liabilities, income flows, contingent obligations, and a signer certification to support verifiable decisions.

Identification

Full legal name, SSN/TIN, date of birth, current address, and contact details to match identity verification and credit files.

Asset Schedule

Separate sections for cash, accounts, securities, retirement funds, real property (market value and mortgages), vehicles, and other tangible or intangible assets.

Liability Schedule

Itemize secured and unsecured debts, creditor names, outstanding balances, monthly payments, and maturity dates for accurate debt servicing calculations.

Income and Expenses

Document gross income sources, regular expenses, alimony or child support, and nonrecurring receipts to support affordability and cash-flow analysis.

Contingent Obligations

Disclose guarantees, co-signed loans, pending lawsuits, and other potential liabilities that could affect net worth under stress scenarios.

Certification

A signer declaration stating that information is true and complete, followed by signature, printed name, title (if applicable), and date.

Essential Data Fields to Include

Name and ID: Full legal name
Contact Details: Current mailing address
Income Summary: Total gross income
Assets Total: Combined asset value
Liabilities Total: Combined debt value
Signature Date: Signed and dated

Step-by-Step: Filling Out a Personal Financial Statement

Follow these steps to prepare a complete and verifiable statement suitable for lenders, courts, or professional review.

  • 01
    Gather Documents: Collect bank statements, loan statements, deeds, and investment statements for current values.
  • 02
    Fill Identification: Enter legal name, SSN/TIN, address, and report date in MM/DD/YYYY format.
  • 03
    Record Balances: Enter current market values for assets and outstanding balances for liabilities.
  • 04
    Review and Sign: Confirm totals, initial revisions, sign the certification, and date the form before submission.

How to Customize and Submit the Form Online

Configure a digital workflow that captures required fields, supports authentication, and routes the completed form to recipients.

Field Configuration
Document Format PDF, DOCX, or HTML accepted; preserve original layout for legal copying.
Authentication Email link, SMS code, or advanced signer verification for higher assurance.
Attachments Allow uploads for supporting documents such as bank statements and property deeds.
Routing Set sequential or parallel signing order and automatic notifications upon completion.

Where to Send a Completed Personal Financial Statement

Identify the intended recipient and choose a secure delivery method to maintain confidentiality and chain of custody.

  • Lender Submission: Upload to lender portal or send via secure file transfer with recipient confirmation.
  • Advisor or Accountant: Provide a signed copy to your CPA or financial adviser for review and tax planning.
  • Legal Counsel: Deliver to your attorney when used in litigation, divorce, or estate matters.
  • Internal Record: Retain an encrypted copy in your document management system for future reference.

Digital Signing and eSubmission: Platform Considerations

Choose a platform that supports secure signatures, audit trails, and the file formats you use.

  • File Types: PDF, DOCX, and HTML compatibility
  • Integrations: Salesforce, NetSuite, Google Workspace supported
  • Security: TLS in transit and AES-256 at rest

Ensure the platform you use can retain an auditable record of who signed, when, and with what authentication method.

Timing: When to Provide or Update the Form

Timeliness affects underwriting and compliance; provide the form when requested and update it regularly to reflect material changes.

Loan Application:

Provide the statement with initial loan paperwork or at pre-qualification.

Refinancing:

Submit an updated statement during refinancing or rate negotiation.

Annual Update:

Many lenders request annual updates for existing credit facilities.

Upon Material Change:

Update if net worth, major assets, or liabilities change substantially.

Legal Requests:

Provide promptly when ordered by a court or required in discovery.

Common Errors to Avoid When Completing the Form

  • Listing outdated asset values leads to understating liabilities or overstating net worth and triggers lender re-verification requests.
  • Omitting contingent liabilities such as guarantees or pending litigation can result in later discovery and potential legal consequences.
  • Using inconsistent naming (nickname vs. legal name) or incorrect SSN/TIN can delay processing and cause identity verification failures.
  • Failing to attach supporting statements or bank records commonly leads to conditional approvals or requests for additional documentation.

Consequences of Inaccurate or Incomplete Statements

Loan Denial: Possible refusal
Default Clauses: Covenant breach risks
Legal Exposure: Fraud allegations possible
Tax Impact: Incorrect reporting
Credit Damage: Lower credit scores
Withholding: Backup withholding risk

Real-World Examples of How the Form Is Used

These short case arcs show typical contexts where a Personal Financial Statement is required and how it supported a decision or process.

Small Business Loan

A founder completed a Personal Financial Statement to apply for a $150,000 SBA loan, providing bank and real estate values

  • Lender required notarized signature and supporting statements
  • The consolidated form enabled faster underwriting and clarified the founder’s collateral, shortening the approval timeline and reducing conditional requests.

Divorce Proceeding

During divorce litigation, a spouse submitted a detailed Personal Financial Statement and attachments showing retirement account balances

  • Court required verified asset disclosures
  • The structured statement and certified documents simplified equitable distribution calculations and limited follow-up discovery.

eSignature Vendor Comparison for Signing and Managing Personal Financial Statements

Compare primary features and starting prices for common eSignature vendors; signNow is listed first for reference to platform-specific cost and compliance options.

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 Yes, 7-day free trial Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently Asked Questions About the Personal Financial Statement Form

Answers to common questions about signing, notarization, legal effect, and best practices when submitting a Personal Financial Statement.


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