Statement of income and expenditure Balance sheet - for an individual or firm

Monthly income Confidential

Salary - self
Allowances in cash Use this form if... Hierdie vorm is ook beskikbaar in Afrikaans - vorm nommer 00047775
Commissions a formal balance sheet and profit
and loss account have not been
Investments prepared
Salary - spouse
Other (specify)

Total income R Branch

Monthly expenditure
Tax - PAYE / SITE
Pension
UIF
Medical aid
Balance sheet details
Rent / Bond payments
Hire purchase instalments Balance sheet of:
i.e Your name or the name of
Lease agreements your business

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 Bank account details
Planned savings if you have signed as surety
Credit card accounts
Bank
Donations
Education - fees, books etc.
Branch
Childrens' clothing
Groceries
Account number
Clothing accounts
Doctor / Chemist
Domestic / Garden help Type of account

Security system
Transport (petrol, bus fare, parking etc) Surety on account of

Entertainment
TV rental / M-Net
Other (specify)
Other (specify)
Other (specify)
Other (specify)

Total expenditure R
Total income - Total expenditure =
Surplus available R

00049414 2001-06 Page 4 of 4 00049414 2001-06 The Standard Bank of South Africa Limited Reg No 1962/000738/06 Registered Bank Page 1 of 4
Balance sheet of as at date
Y Y Y Y M M D D
Assets State if any assets are encumbered Date purchased Municipal Present value Liabilities
Farm name / Name of bondholder / Annual capital Maturity Amounts owing
Fixed property Farm name / Plot no. Size District / Suburb and price paid valuation Rand For Bank use only Mortgage bonds Plot no. seller reductions date Rand
Give particulars of each and / or amounts owing
property separately, stating under deeds of sale
whether freehold or leasehold
and state if affected by any
servitudes, usufruct or
fiduciary interests.
Machinery, Plant, Owing under To whom owing Instalment amount
Implements, etc instalment
Specify important items only sale / lease
agreements

Vehicles
State make, model and year Loans from Type of loan Interest rate Date repayable Instalment amount
of first registration Standard Bank

Furniture and fittings

Other assets
Loans from other Name of bank / financial institution Interest rate Date repayable Instalment amount
e.g. antiques, carpets,
jewellery, stamp collections, banks / financial
coins, etc. institutions
(Including insurance
companies)
Date Maturity
Life assurance policies Company Number issued date Amount If ceded to whom Surrender value less loans
State briefly the
Surrender value of Life policies security given
payable to the undersigned and
not to any third party Owing on credit Type of card Name of company Limit Interest rate Instalment amount
cards
e.g Mastercard, Visacard,
Garage Card, Woolworths,
Truworths, Edgars cards,
Loans By whom due Interest rate Date repayable etc.
If security held please give
brief details
Bills payable
Sundry creditors

Investments Liability for

income tax Date last assessment paid:
e.g Private company etc
Other liabilities Description Period Terms of repayment

Listed shares Company Number held Market value

Including Unit Trust investments

Trading assets Contingent In favour of whom Which institution Amount

(applicable to firms only) Stock in trade liabilities
as Guarantor, Surety
Work in progress or otherwise
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)

Cash on hand Total liabilities R

Your signature
Total assets 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
Less Total liabilities R than as stated above.
Surplus / Deficit of I / We agree that the bank may verify the information contained in this statement and may make any enquiries it considers necessary
assets over liabilities R
Your signature as at date
Y Y Y Y M M D D

00049414 2001-06 Page 2 of 4 00049414 2001-06 Page 3 of 4