Personal Financial Statement
Confidential — Complete all applicable sections
Total Assets
$0
Total Liabilities
$0
Net Worth
$0
Applicant Information
▾
Assets & Liabilities
▾
Assets
Cash on Hand & in Banks
$
Savings Accounts
$
IRA / Retirement Accounts
$
Accounts & Notes Receivable
$
Life InsuranceCash surrender value only
$
Stocks & Bonds
$
Real EstateCurrent market value
$
AutomobilesSee vehicle detail below
$
Business Interest(s)
$
Other Assets
$
Liabilities
Accounts Payable
$
Notes Payable to Banks
$
Auto Loan Balance
$
Credit Card Balances
$
Student Loans
$
Loans Against Life Insurance
$
Mortgages on Real Estate
$
Unpaid Taxes
$
Business Debts
$
Other Liabilities
$
Sources of Income & Contingent Liabilities
▾
Annual Income
Salary / Wages
$
Business Income (Net)
$
Investment Income
$
Rental Income
$
Other Income
$
Contingent Liabilities
As Endorser / Co-Maker
$
Legal Claims & Judgments
$
Pending Tax Liabilities
$
Guarantees
$
Other Special Obligations
$
Notes Payable to Banks & Others
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Name & Address of NoteholderOriginal BalanceCurrent BalancePayment AmountFrequencyCollateral / Security
Stocks & Bonds
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# SharesSecurity Name / TickerCost BasisMarket ValueExchangeDate of QuoteTotal Value
Real Estate Owned
▾
Property A
Property B
Property C
Vehicle Detail
▾
Vehicle 1
Vehicle 2
Vehicle 3
Other Personal Property & Assets
▾
Unpaid Taxes & Other Liabilities
▾
Unpaid Taxes
Other Liabilities
Life Insurance Held
▾
Insurance CompanyFace AmountCash Surrender ValueBeneficiaryPolicy Number
Certification & Signature
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The undersigned certifies that all information provided in this Personal Financial Statement is true, accurate, and complete as of the date indicated. The undersigned authorizes SCL Private Funding Network to verify any information contained herein and acknowledges that material misrepresentation may result in denial of financing or other legal consequences.
SCL Private Funding Network · Personal Financial Statement · Confidential