NEW VENTURE GUIDE
by the UALR Arkansas Small Business Development Center
Personal Financial Statement
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 |
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| Section 3. Stocks and Bonds |
Number of
Shares |
Name of Securities |
Cost |
Market Value
Quotation |
Date of
Quotation |
Total
Value |
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| Section 4. Real Estate Owned. |
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Property A |
Property B |
Property C |
| Type of Property |
|
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Name & Address
of Title Holder |
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| Date Purchased |
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| Original Cost |
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| Present Market Value |
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Name & Address
of Mortgage Holder |
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| Mortgage Balance |
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Amount of Payment per
Month/Year |
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| Status of Mortgage |
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| Section 5. Other Personal Property and Other
Assets. |
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| Section 7. Other Liabilities. |
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| Section 8. Life Insurance Held. (Face amount,
cash surrender value, insurance company, and beneficiary) |
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| 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.
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The Arkansas Small Business Development Center is funded in part through a
cooperative agreement with the U.S. Small Business Administration through a
partnership with the University of Arkansas at Little Rock College of Business
and other institutions of higher education. All opinions, conclusions or
recommendations expressed are those of the author(s) and do not necessarily
reflect the views of the SBA. It is the goal of UALR to eliminate discriminatory
harassment and to promote equal opportunity regardless of race, gender, color,
national origin, sexual orientation, age, religion, veteran’s status, or disability.
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