CONFIDENTIAL

Personal Financial Statement DATE:

PREPARED FOR:

APPLICANT CO-APPLICANT

Full Name: Full Name:

Phone (home): Phone (home):
Phone (work): Phone (work):

Current Address Current Address

Street Address: Street Address:
City/State/Zip: City/State/Zip:
County: County:
Since: Since:
Own or Rent: Rent $: Own or Rent: Rent $:
Previous Address (if less than 5 years at current) Previous Address (if less than 5 years at current)
Street Address: Street Address:
City/State/Zip: City/State/Zip:
County: County:
Since: Since:
Owned or Rented: Owned or Rented:

Sensitive Personal Information Sensitive Personal Information

Social Sec. #: Social Sec. #:
Date of Birth: Date of Birth:
# of Dependents: (include self) # of Dependents: (include self)
Marital Status: Marital Status:

Employment Employment
Current Employer: Current Employer:
Address: Address:
Position/Title: Position/Title:
Since: Since:

Previous Employer: Previous Employer:

Address: Address:
Position/Title: Position/Title:
How Long: How Long:

Certification

By signing this form, I certify that the information provided in this statement is true and correct.

x x
Applicant Signature Date Co-Applicant Signature

CONFIDENTIAL
 CONFIDENTIAL

Personal Financial Statement

2015 Vertex42 LLC

NOTE: This spreadsheet is not meant to be a

legal document. Banks and lenders will likely
have their own forms you need to fill out for loan
applications. This spreadsheet was designed
to help you save information so that completing
the necessary forms will be easier.

For security reasons, do not save this file with

your social security number and date of birth.
Because this file will include personal financial
data, store this file securely.
at current)

de self)

Date

CONFIDENTIAL
 CONFIDENTIAL

Personal Balance Sheet As of: 7/16/2015

Assets
Cash
Checking Accounts Schedule 1: 5,000
Savings Accounts Schedule 1: -
CDs (certificates of deposit) Schedule 1: -
Other Cash
Total Cash 5,000
Investments
Life Insurance (cash surrender value) Schedule 2: -
Brokerage Accounts (non-retirement) Schedule 3: -
Securities (stocks, bonds, mutual funds) Schedule 4: -
Investment Real Estate (market value) Schedule 5b: -
Treasury Bills/Notes
Other Investments
Total Investments -
Personal Property
Primary Residence (market value) Schedule 5a: 200,000
Automobiles (present value) Schedule 9:
Bullion (silver, gold, etc) Schedule 9:
Jewelry, Art and Collectibles Schedule 9:
Other property Schedule 9:
Total Property 200,000
Retirement
Retirements Accounts (IRA, 401k) Schedule 6: 20,000
Pension and Project Sharing Schedule 7: -
Social Security ($/month * 240) -
Other Assets -
Total Retirement 20,000
Notes and Accounts Receivable
Notes and Accounts Receivable Schedule 8: -
Other Notes -
Total Notes -

Total Assets 225,000

Liabilities
Mortgages on Real Estate Schedule 5a: -
Mortgages on Investment Real Estate Schedule 5b: -
Credit Accounts, Bills Due, etc. Schedule 10: 1,000
Student Loans -
Accounts Payable -
Loans and Notes Payable to Bank and Others Schedule 11: -
Loans on Life Insurance Schedule 2: -
Loans on Profit Sharing / Pension Schedule 7: -
Loans on Retirement Accounts Schedule 6: -
Unpaid Taxes (current year) -
Other Liabilities Schedule 12: -
Total Liabilities 1,000

Net Worth (Assets - Liabilities) 224,000

Common Financial Ratios

Debt-to-Assets Ratio (Total Liabilities / Total Assets) 0.44%
Basic Liquidity Ratio (Liquid Assets / Monthly Living Expenses) -
Investment-Assets-to-Net-Worth Ratio (Investment Assets / Net Worth) 8.9%

CONFIDENTIAL
 CONFIDENTIAL

Detailed Account Information

Schedule 1: Checking and Savings Accounts
Institution Type Balance
Bank XYZ Checking 5,000

Insert rows above this line

Total: 5,000

Schedule 2: Life Insurance

Company Insured Beneficiary Face Value Cash Value Loans
XYZ Term Life 200,000 - -
-
-
Insert rows above this line
Total: - -

Schedule 3: Brokerage Accounts (Non-Retirement)

Institution Type Balance

Insert rows above this line

Total: -

Schedule 4: Individual Securities Owned

Name of Security Listed? Shares Price/Share Market Value
-
-
-
-
Insert rows above this line
Total: -

Schedule 5a: Real Estate Owned

Property Type Acquired (yr) Purchase $ Payment Frequency Balance Due Current Value
12345 Somewhere St. Primary 2005 190,000 1,200 Monthly - 200,000

Insert rows above this line

Total: - 200,000

Schedule 5b: Investment Real Estate Owned

Property Type Acquired (yr) Purchase $ Payment Frequency Balance Due Current Value

Insert rows above this line

Total: - -

Schedule 6: IRA, 401(k), SEP and Other Retirement Accounts

Institution Type Balance Loans
XYZ Company 401(k) 401(k) 20,000 -
-
-
-
Insert rows above this line
Total: 20,000 -

CONFIDENTIAL
 CONFIDENTIAL

Schedule 7: Profit Sharing and Pension

Institution Account Type Balance Amount Vested Loans
- -
- -
- -
Insert rows above this line
Total: - - -

Schedule 8: Receivables Due to Me on Loans and Contracts

Name of Debtor, Property 1st or 2nd Lien Maturity Date Payment Frequency Balance Due

Insert rows above this line

Total: -

Schedule 9: Other Property

Property Description Market Value
2013 Honda Accord 20100 miles good condition 15,000

Insert rows above this line

Total: 15,000

Schedule 10: Credit Accounts, Bills Due, Alimony/Child Support, Daycare, etc.
Name of Company Type Payment Frequency Balance Due
XYZ Credit Union CCard 1,000

Insert rows above this line

Total: 1,000

Schedule 11: Loans and Notes Payable to Banks and Others

Name of Creditor Type Collateral Orig. Balance Maturity Date Payment Frequency Balance Due

Insert rows above this line

Total: -

Schedule 12: Other Liabilities

Description Balance Due

Insert rows above this line

Total: -

CONFIDENTIAL
 CONFIDENTIAL

Personal Cash Flow Statement

INFLOWS Last Year Year to Date
Income
Salary, Wages, Commissions
Business Distributions
Rental Income
Interest and Dividends
Social Security Benefits
Retirement Benefits
Child Support and Alimony
Realized Capital Gains (Losses)
Other Inflows
Rebates/Refunds/Reimbursements
Gifts Received
Tax Returns
Scholarships and Grants

Total Inflows - -
[42]

OUTFLOWS
Payroll / Income Deductions
Social Security Tax
Medicare Tax
Income Tax: Federal
Income Tax: State
401(k) / Savings Plans
Charitable Contributions
Business Expenses
Rental Maintenance
Rental Insurance
Financing Activities
MORTGAGE Payments
Loan Payments (car, installment, student, etc.)
Minimum Credit Card Payments
Other Living Expenses
Auto (Insurance, Fuel, Licenses, Service)
Daily Living (Food, Clothing, Supplies, etc.)
Education
Entertainment & Recreation
Health Insurance
Homeowners Insurance (not in escrow)
Life Insurance
Maintenance
Medical
Phone and Internet
Property Tax (not in escrow)
Subscriptions and Dues
Supplies
Utilities (Electicity, Gas, Water)
Vacation and Travel
Miscellaneous

Total Outflows - -
Total Living Expenses (for BLR) - -

Net Cash Flow - -

Common Financial Ratios

Debt-to-Income (debt payments / gross income) - -
Debt Service Ratio (debt payments / annual net income) - -

CONFIDENTIAL
HELP
https://www.vertex42.com/ExcelTemplates/personal-financial-statement.html 2015 Vertex42 LLC

About This Spreadsheet

IMPORTANT: This template was designed for educational purposes. It
is not guaranteed to be free of errors. You should verify all formulas to
make sure that it is doing what you want it to do.

The Balance Sheet is the main part of a personal financial statement. It

is used to total your assets and liabilities and calculate your net worth.
Use the Details worksheet to provide details about your assets and
liabilities.

The purpose of the Cash Flow Statement is to determine your actual

net cash flow (inflows - outflows). It is almost exactly the same as a
budget, except that a budget is a plan or projection and your cash flow
statement is what you actually earned and spent.

The categories have been organized to help calculate some common

financial ratios found at the bottom of the balance sheet and cash flow
statement. If you customize the categories, you will need to verify and
update the formulas used to calculate the ratios.

The Info worksheet was created to represent the type of information

your bank will likely require you to fill out when applying for a loan. It is
not meant to be used in place of the bank's required form.

Additional Help
The link at the top of this worksheet will take you to the web page on
vertex42.com that talks about this template.

REFERENCES

TIPS Vertex42.com: Spreadsheet Tips Workbook

ARTICLE Vertex42.com: How to Make a Budget with a Spreadsheet

ARTICLE Vertex42.com: Budgeting Tips

 2015 Vertex42 LLC
Personal Financial Statement
By Vertex42.com
https://www.vertex42.com/ExcelTemplates/personal-financial-statement.html

2015 Vertex42 LLC

This spreadsheet, including all worksheets and associated content is a

copyrighted work under the United States and other copyright laws.

Do not submit copies or modifications of this template to any website or online

template gallery.

Please review the following license agreement to learn how you may or may
not use this template. Thank you.

https://www.vertex42.com/licensing/EULA_personaluse.html

Do not delete this worksheet.