STATEMENT OF PERSONAL ASSETS AND LIABILITIES Individual Name: LIABILITIES ASSETS Bank Overdraft:with Cash at State Bank Cheque a/c Savings a/c Mortgages on Property To Monthly Payment $ Freehold Property: At owned in Name of: To Monthly Payment $ At owned in Name of: To Monthly Payment $ At owned in Name of: Rates, Tax provisions etc Work in Progress &/or Stock in Trade Trade Creditors Debtors (Good) Sundry Loans Sundry Loans Owing on Plant and Machinery to Plant and Machinery Owing on Motor Vehicles Motor Vehicle Furniture Other Liabilities: Other Assets Investments etc: Total Liabilities Total Assets Surplus of Assets over Liabilities Surplus of Liabilities over Assets Total $ Total $ I/We declare that the above information is true and correct in every particular and it is upon the basis that I/We make this application. Signed for and on behalf of Date