Fillable Printable Income statement Example
Fillable Printable Income statement Example
Income statement Example
BUSINESS FINANCIAL STATEMENT
Use of company financial statement forms is not mandatory. They are made available as guides to the type of information needed.
Signed statements on comparable bank forms, or on your accountant's letterhead, are equally acceptable under most circumstances.
Fiscal or year end statements are preferred. Schedules should be completed where they are meaningful.
Financial Statement of
(Name)
(Street Address, City, State, ZIP)
AS OF
(Date)
CURRENT ASSETS CURRENT LIABILITIES
Cash on Hand (not in bank)...................... Notes payable (Schedule 6)........................
Cash in banks (Schedule 1)........................ ....................................................................
.................................................................... ....................................................................
Stocks and Bonds (Schedule 2).................. ....................................................................
Accounts Receivable (Trade)..................... Accounts Payable ......................................
.................................................................... ....................................................................
Notes receivable (Schedule 3) ................... Current portion of long term debt ............
Cash value of life insurance....................... (Due within one year)
.................................................................... ....................................................................
Other current assets (itemize) .................. Other current liabilities (itemize).............
.................................................................... ....................................................................
.................................................................... ....................................................................
.................................................................... ....................................................................
.................................................................... ....................................................................
TOTAL CURRENT ASSETS TOTAL CURRENT LIABILITIES
FIXED ASSETS
LONG TERM LIABILITIES
Real Estate (Schedule 4)............................ Real estate debt (Schedule 4) ....................
Business ...................................... ....................................................................
Other ......................................... ....................................................................
.................................................................... ....................................................................
Business vehicles & equip. (Sched. 5) Owing on vehicles & equipment
.................................................................... (Schedule 5)................................................
.................................................................... ....................................................................
Other assets and investments (itemize) Other long term debt (itemize) .................
.................................................................... ....................................................................
.................................................................... ....................................................................
.................................................................... ....................................................................
TOTAL FIXED ASSETS TOTAL LONG TERM LIABILITIES
NET WORTH
TOTAL ASSETS
TOTAL LIABILITIES
Net Sales $ _____________________________
Net Profit $ ____________________________
Drawings or owner's salary $ _____________
Contingent liabilities $ ___________________
SUPPLEMENTARY SCHEDULES
(NOTE: If space is insufficient, attach separate sheet with additional information)
SCHEDULE 1 - CASH
Name, Branch & Location of Bank
Amount
SCHEDULE 2 - STOCKS AND BONDS
Name of Security
No. of Shares Price Per Share Total Market
Value
Listed Securities
Unlisted Securities
SCHEDULE 3 - NOTES RECEIVABLE
Name & Address of Debtor
Amount Due Date Security Pledged?
To Whom?
SCHEDULE 4 - REAL ESTATE
Location/Description
Year
Acq'd
Cost
Market
Value
Monthly
Income
Monthly
Payment
Mortgage
Balance
Mortgage or
Lien Holder
SCHEDULE 5 - BUSINESS VEHICLES AND EQUIPMENT
Description and Capacity
Year
Mfg'd
Year
Acq'd
Cost Book Value Monthly
Payment
Loan
Balance
SCHEDULE 6 - NOTES PAYABLE
Payable to Whom Due
Date
Interest
Rate
Monthly
Payment
Amount Security
I hereby certify and declare that the above statement presents accurately my financial condition to the best of my knowledge and belief and I hereby
authorize and request any person, firm or corporation to furnish any information requested by the Surety concerning any transaction with the
undersigned; and the said Surety is authorized to obtain information to confirm this financial statement and may furnish copies of the foregoing statement
and any information which it now has or may hereafter obtain to other companies for the purpose of securing reinsurance or co-suretyship.
Signature Date
