Balance sheet - for an individual or firm
Statement of income and expenditure
Confidential
Monthly income
Salary - self
Allowances in cash
Use this form if...
Commissions
a formal balance sheet and profit
and loss account have not been
prepared
Investments
Hierdie vorm is ook beskikbaar in Afrikaans - vorm nommer 00047775
Salary - spouse
Other (specify)
Branch
Total income R
Monthly expenditure
Tax - PAYE / SITE
Pension
UIF
Medical aid
Balance sheet details
Rent / Bond payments
Balance sheet of:
Hire purchase instalments
i.e Your name or the name of
your business
Lease agreements
Loan repayments
Insurance premiums
As at date
Life assurance premiums
Y
Y
Y
Y
M
M
D
D
Electricity and water
Rates and taxes
Telephones including rentals
Alimony / Maintenance
Complete this section only
if you have signed as surety
Planned savings
Credit card accounts
Bank account details
Bank
Donations
Education - fees, books etc.
Branch
Childrens' clothing
Groceries
Account number
Clothing accounts
Doctor / Chemist
Type of account
Domestic / Garden help
Security system
Surety on account of
Transport (petrol, bus fare, parking etc)
Entertainment
TV rental / M-Net
Other (specify)
Other (specify)
Other (specify)
Other (specify)
Total expenditure
R
Total income - Total expenditure =
Surplus available
00049414 2001-06
R
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00049414 2001-06
The Standard Bank of South Africa Limited Reg No 1962/000738/06 Registered Bank
Page 1 of 4
as at date
Balance sheet of
Y
Assets
State if any assets are encumbered
Fixed property
Farm name / Plot no.
Give particulars of each
property separately, stating
whether freehold or leasehold
and state if affected by any
servitudes, usufruct or
fiduciary interests.
Size
District / Suburb
Date purchased
and price paid
Present value
Rand
Municipal
valuation
Y
Y
Y
M
Liabilities
For Bank use only
Mortgage bonds
M
D
D
Farm name /
Plot no.
Name of bondholder /
seller
Annual capital
reductions
Amounts owing
Maturity
date
Rand
and / or amounts owing
under deeds of sale
Machinery, Plant,
Implements, etc
Specify important items only
Owing under
instalment
sale / lease
agreements
To whom owing
Loans from
Standard Bank
Type of loan
Interest rate
Date repayable
Instalment amount
Loans from other
banks / financial
institutions
Name of bank / financial institution
Interest rate
Date repayable
Instalment amount
Limit Interest rate
Instalment amount
Instalment amount
Vehicles
State make, model and year
of first registration
Furniture and fittings
Other assets
e.g. antiques, carpets,
jewellery, stamp collections,
coins, etc.
Life assurance policies Company
Number
Date
issued
Maturity
date
(Including insurance
companies)
Amount
If ceded to whom
Surrender value less loans
State briefly the
security given
Surrender value of Life policies
payable to the undersigned and
not to any third party
By whom due
If security held please give
brief details
Loans
Owing on credit
cards
Interest rate
Type of card
Name of company
e.g Mastercard, Visacard,
Garage Card, Woolworths,
Truworths, Edgars cards,
etc.
Date repayable
Bills payable
Sundry creditors
Liability for
income tax
Other liabilities
Investments
e.g Private company etc
Listed shares
Company
Date last assessment paid:
Description
Period
In favour of whom
Which institution
Terms of repayment
Market value
Number held
Including Unit Trust investments
Trading assets
(applicable to firms only)
Stock in trade
Contingent
liabilities
Work in progress
as Guarantor, Surety
or otherwise
Amount
Book debts (Do not include Factored Book Debts)
Bills receivable (Do not include discounted Bills Receivable)
Total R
Bank credit balances/
Deposits
(specify the name of the financial
institution and type of account)
Total liabilities R
Cash on hand
Total assets
Your signature
R
I / We declare that this is a full, true and correct statement of my / our position and that my / our assets are not encumbered other
than as stated above.
I / We agree that the bank may verify the information contained in this statement and may make any enquiries it considers necessary
Less Total liabilities
R
Surplus / Deficit of
assets over liabilities R
Your signature
as at date
Y
00049414 2001-06
Page 2 of 4
00049414 2001-06
Y
Y
Y
M
M
D
D
Page 3 of 4