Assets Statement Form

An asset statement form contains the financial status of the applicant within the last twelve months. It contains factual figures on the current assets in hand of the individual such as cash in hand or in banks, mortgages owned or marketable securities, real estate assets, income earned from various sources, any interest in a closely held business and so on.

Sample Asset Statement Form

Asset statement submitted for:

• Individual
• Corporation
• Limited Partnership
• Not for Profit
• If any other, please mention

Personal Information:

Name:        _______________________                 Phone: _______________________                          Marital Status: _______________________           Residence Address: _______________________           Business Address: _______________________      City: _______________________

State: ______________________                  Position (Title): _______________________        Salary: _______________________                      Other Income: _______________________

Years of service: _______________________  Gross Life Insurance: _______________________    Beneficiaries:    _______________________

Are you a defendant in any lawsuits or legal action?  If so, describe below:

Assets                                                                          Figure/Facts

Cash on hand and in banks: —————-

Notes receivable from bank:                             —————-

Mortgages Owned:                                            —————- (In Rs.)

Marketable Securities:                                      —————- (In Rs.)

Cash Value of Life Insurance:                           —————-

Real Estate:

Address     Title in name of   % of Ownership          Date Acq.  Market Value    Maturity Date

Income from Properties (If any):

Property No. :

Present Annual Gross Income:

Less Total Operation Expenses and Property Taxes:                                                            Net Income:

Income Payments:

Net Profit:

Net Rental Value of Present Vacancies:

Annual Rental Value of Space:

Net Profit Last Year:

List Other Debts, Taxes, Mortgage Instalments or Interest Past Due:

Category: Statement Forms