CONFIDENTIAL B LIFE INSURANCE (List only those Policies that you own) Company Cash Surrender Value Policy Loan from Insurance Co. Other Loans Policy...
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Download ABSTRAK. Penelitian ini bertujuan untuk mengetahui pengaruh Return on Assets dan Debt to Equity Ratio terhadap Harga Saham pada Institusi Finansial di Bursa Efek Indonesia. Penelitian ini menggunakan data sekunder. Sampel yang digunaka
CONFIDENTIAL
PERSONAL FINANCIAL STATEMENT Statement Date: Personal Information Name: Address: City, State Zip: Home Telephone:
Cash on Hand & in Banks Cash Value of Life Insurance U.S. Gov. Securities Other Marketable Securities Notes & Accounts Receivable - Good Other Assets Readily Convertible to Cash - Itemize
TOTAL CURRENT ASSETS Real Estate Owned Mortgages & Contracts Owned Notes & Accounts Receivable - Doubtful Notes Due from Relatives & Friends Other Securities - Not Readily Marketable Personal Property Other Assets - Itemize
$0.00
TOTAL ASSETS
$0.00
ANNUAL INCOME Salary, Bonuses & Commissions Dividends & Interest Rental & Lease Income (Net) Other Income - Itemize Other Persons Salary, Bonuses & Commissions Other Income of Other Person - Itemize Total
LIABILITIES Notes Due to Banks Notes Due to Relatives & Friends Notes Due to Others Accounts & Bills Payable Unpaid Income Taxes Due - Federal State Other Unpaid Taxes & Interest Loans on Life Insurance Policies Contract Accounts Payable Cash Rent Owed Other Liabilities Due within 1 Year - Itemize
TOTAL CURRENT LIABILITIES Real Estate Mortgage Payable Liens & Assessments Payable Other Debts - Itemize
$0.00
TOTAL LIABILITIES Net Worth (Total Assets - Total Liabilities) TOTAL LIABILITIES & NET WORTH
$0.00 $0.00 $0.00
ESTIMATE OF ANNUAL EXPENSES Income Taxes Other Taxes Insurance Premiums Mortgage Payments Rent Payable Other Expenses $0.00 Total
GENERAL INFORMATION Are any Assets Pledged? No Yes Are you a Defendant in any Suits or Legal Actions? (Explain)
No No
Have you ever been declared Bankrupt in the last 10 years?
(Explain)
$0.00
CONTINGENT LIABILITIES As Endorser, Co-maker or Guarantor- Yes Yes On Leases or Contracts Legal Claims Yes Federal - State Income Taxes Other -
Section II A CASH IN BANKS AND NOTES DUE TO BANKS Name of Bank
Type of Account
Type of Ownership
Cash on Hand TOTALS
On Deposit
Notes Due Banks
$0.00
PERSONAL FINANCIAL STATEMENT
COLLATERAL (If any) & Type of Ownership
$0.00
1
CONFIDENTIAL
SECTION II (Continued) B LIFE INSURANCE
Company
(List only those Policies that you own)
Cash Surrender Value
Face of Policy
Policy Loan from Insurance Co.
$0.00
TOTALS
Other Loans Policy as Collateral
BENEFICIARY
$0.00
C SECURITIES OWNED Face Value-Bonds No. of Shares Stock
Indicate those Not Registered in Your
Type of Ownership
Market Value U.S. Gov. Sec.
COST
TOTALS
D NOTES AND ACCOUNTS RECEIVABLE MAKER/DEBTOR
X
When Due
$0.00
TITLE IN NAME OF
Description & Location
X
Mortgage
X
$0.00
$0.00
$0.00
(Indicate by a X if Others have an Ownership Interest) Present Value of Real Date Acquired Original Cost Estate
Amount of Ins. Carried
TOTAL
TOTAL
Maker Name
$0.00
Amount Pledged to Secured Loans
$0.00
(Money Payable or Owed to You Individually-Indicate by a X if Others have an Ownership Interest) Bal. Due Notes Rel. & Balance Due Good Balance Due Doubtful Accounts Accounts Friends
F MORTGAGES AND CONTRACTS OWNED Contract
MARKET VALUE Not Readily Marketable SECURITIES
Original Amount
TOTALS
E REAL ESTATE OWNED
Market Value Marketable Sec.
Security (if any)
$0.00
MORTGAGE OR CONTRACT PAYABLE Bal. Due
Payment
Maturity
To Whom Payable
Payment
Maturity
Balance Due
$0.00
(Indicate by a if Others have an Ownership Interest)
Maker Address
Start Date
Property Covered
TOTALS
G PERSONAL PROPERTY DESCRIPTION
X
(Indicate by a X if Others have an Ownership Interest) Date When New
Cost When New
TOTAL
H NOTES
$0.00
Value Today
Balance Due
$0.00
(Other than Bank, Mortgage and Insurance Company Loans) Other Obligors (if any) When Due
Notes Due To Rel. & Friends
Notes Due 'Others' (Not Banks)
TOTALS
$0.00
$0.00
PAYABLE TO
To Whom Payable
Accounts & Bills Payable
$0.00
Contracts Payable
COLLATERAL (if any)
$0.00
For the purpose of procuring credit from time to time, I/We furnish the foregoing as a true and accurate statement of my/our financial condition. Authorization is hereby given to the Lender to verify in any manner it deems appropriate any and all items indicated on this statement. The undersigned also agrees to notify the Lender immediately in writing of any significant adverse change in such financial condition.
