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PERSONAL FINANCIAL STATEMENT

PERSONAL FINANCIAL STATEMENT as of September 22, 2017 OF _________________________ of _________________________ (the "Applicant") FOR _________________________ of _________________________.

BACKGROUND:

This Personal Financial Statement is being made for the purpose of: ________________________________________________________________________.

Applicant #1 Personal Information
Name: _________________________
Address: _________________________
Phone: __________
Employer: _________________________
Position: _________________________
Number of Years at Position: _________________________

Section 1. Balance Sheet

Assets

Value

Liabilities

Value

Cash on hand

$0.00

Unpaid Taxes

$0.00

Cash in Bank

$0.00

Loans Payable to Financial Institution

$0.00

Debt Owed to Applicant

$0.00

Other Loans

$0.00

Retirement Accounts

$0.00

Credit Cards

$0.00

Motor Vehicles

$0.00

Amount Owing on Motor Vehicle

$0.00

Real Estate

$0.00

Amount Owing on Real Estate

$0.00

Investments

$0.00

Other Liabilities

$0.00

Cash Value Life Insurance

$0.00

   

Other Assets

$0.00

   
   

Total Liabilities

$0.00

       
   

Net Worth Calculation:

Value

       

Total Assets

$0.00

Net Worth

$0.00

Section 2. Annual Income/Contingent Liabilities

Annual Income

Value

Contingent Liabilities

Value

Salary

$0.00

Endorser/Guarantor

$0.00

Commissions/Bonuses

$0.00

Legal Claims

$0.00

Real Estate Income

$0.00

Other Contingent Liabilities

$0.00

Investments

$0.00

   

Other Income

$0.00

   

Total

$0.00

Total

$0.00

The Applicant certifies that all the information provided in this statement is true and accurate as of September 22, 2017. The Applicant authorizes  _________________________ to make any inquiries that _________________________ feels is necessary to verify the information in this financial statement.

_______________________________
_________________________

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