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PERSONALFINANCIALSTATEMENT2015 .pdf


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WORLD WIDE BONDING AGENCY
2846 WILLIAM STREET,
BUFFALO,FINANCIAL
NEW YORK 14227
PERSONAL
STATEMENT
PH 888-681-7685

FAX 716-681-7683
Agent ________________________________________________________________________________________
Bond No. ___________________
www.wwbagency.com

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. When in doubt, ask your agent about the company’s specific requirements for
the type of credit which you need.

PERSONAL FINANCIAL STATEMENT

Financial statement of
(Name)
(Street Address, City, State, ZIP)

FINANCIAL CONDITION AS OF ___________________________, 20 ___________
ASSETS

AMT(S) ONLY

Cash on Hand
Cash in following Banks (name & address):

LIABILITIES

AMT(S) ONLY

NOTES PAYABLE TO BANKS
name & address): ..........................................................

................................................................................................

.........................................................................................

................................................................................................

OTHER NOTES AND ACCOUNTS PAYABLE

STOCKS AND BONDS
Listed (Schedule 1).................................................................

Real Estate Loans (Schedule 4)......................................

Unlisted (Schedule 1) .............................................................

Sales Contracts & Sec. Agreements (Schedule 5)..........
Loans on Life Insurance Policies (Schedule 6) ...............

REAL ESTATE
Improved (Schedule 4) ...........................................................

TAXES PAYABLE

Unimproved (Schedule 4).......................................................

Current Year Income Taxes Unpaid ................................

Trust Deeds & Mortgages (Schedule 3) .................................

Prior Year Income Taxes Unpaid ....................................
Real Estate Taxes Unpaid ...............................................

LIFE INSURANCE
Cast Surrender Value (Schedule 6)........................................

OTHER LIABILITIES
Unpaid Interest ................................................................

ACCOUNTS AND NOTES RECEIVABLE
Relatives and Friends (Schedule 2/3) ....................................

Other (Itemize).................................................................

Other (Schedule 2/3) ..............................................................

.........................................................................................
.........................................................................................

Doubtful (Schedule 2/3)..........................................................

TOTAL LIABILITIES ........................................................
OTHER PERSONAL PROPERTY
Automobile (Schedule 5) ........................................................

NET WORTH ...................................................................

Other (Itemize, Schedule 5)....................................................
TOTAL

TOTAL
(Refer to Federal Income Tax
Returns for Previous Year)

ANNUAL INCOME

ANNUAL EXPENDITURES

SALARY OR WAGES ................................................................

PROPERTY TAXES AND ASSESSMENTS.......................

DIVIDENDS AND INTEREST ....................................................

FEDERAL AND STATE INCOME TAXES ..........................

RENTALS (GROSS) ..................................................................

REAL ESTATE LOAN PAYMENTS ....................................

BUSINESS OR PROFESSIONAL INCOME (NET) ...................

PAYMENTS ON CONTRACTS & OTHER NOTES ............

OTHER INCOME (DESCRIBE) .................................................

INSURANCE PREMIUMS...................................................

(Refer to Federal Income Tax
Returns for Previous Year)

ESTIMATED LIVING EXPENSES ......................................
OTHER
TOTAL INCOME

TOTAL INCOME

To assist the Surety in its evaluation of the above Statement, I hereby certify that all material facts relating to the following conditions are set forth in the attached exhibit(s)
incorporated herein by reference: Contingent liabilities as endorser, co-maker or guarantor $____________________________
Contingent liabilities on leases or contracts $____________________________; pledge or hypothecation of assets $____________________________;
Legal Claims $____________________________; Tax Liens $____________________________
(S)
ID-1256 (REV. 9/00) • PAGE 1 of 2

CONFIDENTIAL

1. STOCKS AND BONDS
Name of Security

No.
Shares

If any pledged, State to Whom
and for What Purpose

Dividends Paid
Last Two Years

Market Value

TOTAL

$

2. ACCOUNTS RECEIVABLE
Name and Address (street and city) From Whom Due

For What Is It Due

When Sold When Due

TOTAL

Amount

$

3. NOTES RECEIVABLE
Name and Address (street and city) From Whom Due

For What Due

How Secured

Date

Maturity

TOTAL

Amount

$

4. REAL ESTATE
Title in
Name Of

Description of Property

Market Value

Amount
Encumbrance

Cost

TOTAL

$

$

Monthly
Payments

Monthly
Income

$

$

5. EQUIPMENT
Description and Capacity of Items

Age of
Item

TOTAL

$

Monthly
Payment

Encumbrance

Cost

Market Value

$

$

6. LIFE INSURANCE – CASH VALUE
Name of Company

Policy Number

Name of Insured

Beneficiary

Face Value

Cash Value

Amount Borrowed

The maker of the foregoing or accompanying statement hereby authorizes the company to confirm the bank balances claimed and all other items comprising
said statement.

Dated ______________________________________, 20________
SIGNATURE:

ID-1256 (REV. 9/00) • PAGE 2 of 2


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