NEW VENTURE GUIDE
by the UALR Arkansas Small Business Development Center
As of ___________________
| Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning 20% or more of voting stock and each corporate officer and director, or (4) any other person or entity providing a guaranty on the loan. | |
| Name | Business Phone ( ) |
| Residence Address | Residence Phone ( ) |
| City, State, & Zip Code | |
| Business Name of Applicant/Borrower | |
| ASSETS (Omit Cents) | LIABILITIES (Omit Cents) | ||
| Cash on hands & in Banks | Accounts Payable | ||
| Savings Accounts | Notes payable to Banks and Others (Describe in Section 2) | ||
| IRA or Other Retirement Account | Installment Account (Auto) Monthly Payment $_____ | ||
| Accounts & Notes Receivable | Installment Account (Other) Monthly Payment $_____ | ||
| Life Insurance -- Cash Value Only (Complete Section 8) | Loans on life Insurance | ||
| Stocks & Bonds (Describe in Section 3) | Mortgages on Real Estate (Describe in Section 4) | ||
| Real Estate (Describe in Section 4) | Unpaid Taxes (Describe in Section 6) | ||
| Automobiles(s) -- Present Value | Other Liabilities (Describe in Section 7) | ||
| Other Personal Property (Describe in Section 5) | Total Liabilities | ||
| Other Assets (Describe in Section 5) | Net Worth | ||
| Total | Total | ||
| Section 1. Sources of Income | Contingent Liabilities | ||
| Salary | As Endorser or Co-Maker | ||
| Net Investment Income | Legal Claims & Judgments | ||
| Real Estate Income | Provision for Federal Income Tax | ||
| Other Income (Describe Below)* | Other Special Debt | ||
| Description of Other Income in Section 1. | |||
| * Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income. | |||
| Section 2. Notes Payable to Bank and Others | |||||
| Name & Address of Noteholder(s) | Original Balance |
Current Balance |
Payment Amount |
Frequency (monthly, etc.) |
How Secured or Endorsed Type of Collateral |
| Section 3. Stocks and Bonds | |||||
| Number of Shares |
Name of Securities | Cost | Market Value Quotation |
Date of Quotation |
Total Value |
| Section 4. Real Estate Owned. | |||
| Property A | Property B | Property C | |
| Type of Property | |||
| Name & Address of Title Holder |
|||
| Date Purchased | |||
| Original Cost | |||
| Present Market Value | |||
| Name & Address of Mortgage Holder |
|||
| Mortgage Balance | |||
| Amount of Payment per Month/Year |
|||
| Status of Mortgage | |||
| Section 5. Other Personal Property and Other Assets. |
| Section 6. Unpaid Taxes. |
| Section 7. Other Liabilities. |
| Section 8. Life Insurance Held. (Face amount, cash surrender value, insurance company, and beneficiary) |
| I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S.Attorney General (Reference 18 U.S.C. 1001). |
| Signature | Date: | Social Security Number: |
| Signature | Date: | Social Security Number: |
Download the Personal Financial Statement (SBA 413)
SBA413.doc
- Personal Financial Statement in Microsoft Word 97 format
Recommend this option if you will complete the form in a word
processor.
SBA413.pdf
- Personal Financial Statement in Adobe Acrobat format
Recommend this option if you will print and then complete the form.
