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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
           
           
           
           
           
           
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.

 

The Arkansas Small Business and Technology 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.