Present Market Value
Mortgage of Land Contract Payable
Balance Owing Monthly Payment Holder Holder
Schedule E: Life Insurance Carried, Including Group Insurance
Name of Insurance Company Owner Policy Beneficiary Face Amount
Cash Surrender Value Policy Loans
I/we also hereby certify that no payment requirements listed herein are delinquent or in default except as follows; (if "NONE" so stated):
we hereby authorize Lender or any credit bureau or other investigative agency employed by it to investigate any information listed herein, or obtained
from me or from any other person pertaining to my financial responsibility. Intending that you shall rely on my statement herein, I hereby certify to you
that the foregoing information is true and complete.
To the best of my knowledge and belief. The attached Financial Statements dated _______________________ is a complete, true and accurate statement.
If an audited financial statement is available, it has been provided.
The financial statement(s) provided corresponds with Borrower's tax returns.
The verification of liquidity (cash, securities, etc.) is attached and corresponds to amounts stated on the financial statement.
I hereby certify that the above statements and additional information are true and correct.
Signature of Principal/Borrower/Guarantor Signature of Co-Principal/Co-Borrower/Co-Guarantor
Principal Name Additional Principal Name
SHF Personal Financial Statement V1.1 Page 4 of 5