Net Worth Statement
Date
-
Month
-
Day
Year
Date
Client 1
*
First Name
Last Name
Client 2
First Name
Last Name
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Assets
Bank Accounts
Real Estate
Automobiles
Personal Property
Loans Receivable
Investments - Please bring, upload or mail current statements for each account
Other Assets
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Liabilities
Mortgages
Bank Loans
Notes Payable to Others
Taxes, Assessments Payable
Other Liabilites
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General Questions
Are any assets pledged?
Please Select
Yes
No
Are you a defendant in a lawsuit?
Please Select
Yes
No
Are you a plaintiff in a lawsuit?
Please Select
Yes
No
Have you ever taken bankruptcy?
Please Select
Yes
No
Are you an endorser or co-maker on any loans?
Please Select
Yes
No
Are there any legal claims against you?
Please Select
Yes
No
Are you on a Board of Directors for any company?
Please Select
Yes
No
Are you on a Board of Directors for any non-profit?
Please Select
Yes
No
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Should be Empty: