Personal Financial Statement Template

PERSONAL FINANCIAL STATEMENT

Prepared For:    Date Prepared:

Personal Information

Schedule of Assets

Cash on hand and in banks:

Marketable securities (list types and market value):
Total marketable securities value:

Retirement accounts (type and current balance):
Total retirement balance:

Automobiles (make, model, year, current value):
Total vehicle value:

Total Assets:

Schedule of Liabilities

Mortgages (list lender, outstanding balance):
Total mortgage balance:

Notes payable to banks/others (describe):
Total notes payable:

Credit card balances (aggregate):

Student loans (aggregate):

Taxes owed (describe):
Total taxes owed:

Total Liabilities:

Income and Expenses (Annual)

Salary/Net wages:

Bonuses/Commissions:

Investment income (interest/dividends):

Rental income:

Total Annual Income:

Total Annual Expenses:

Contingent Liabilities and Other Information

Certifications and Authorization

I certify that the information contained in this Personal Financial Statement is true, complete and correct to the best of my knowledge. I understand that the recipient will rely on this statement in determining creditworthiness or eligibility for services. I authorize the recipient to verify my credit history, employment, and any other information provided herein, and to obtain additional financial information from third parties as required. I agree to notify the recipient in writing of any material changes to this statement during the period in which any credit remains outstanding.

I acknowledge that knowingly making a false or misleading statement in this document may constitute fraud and may result in civil or criminal penalties under applicable law.

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