PERSONAL NET WORTH STATEMENT

Date: Received at Branch

Name: Age:
Employed By:
Address:
Position:
If Employed Less Marital Status
Than One Year,
N/A Children
Previous
Employer: (Sex & Age):

TO BANK ALFALAH LIMITED:

For the purpose of producing and maintaining credit from time to time in any form whatsoever with BANK
ALFALAH LTD the under signed submit(s) the following as being a true and accurate statement of his/her
financial condition on the date mentioned herein and also agree that if any change occurs that materially
reduces the means or ability of the undersigned to pay all claims or demands against him/them, the
undersigned will immediately notify the branch Unless the Bank is to notify it may continue to rely upon the
statement herein given as true and accurate.

Liabilities Rs, 000 Assets Rs, 000

Payable to Bank (Schedule A) Cash on Hands
Secured With BAL
Un – secured With Other Banks
Creditors Investments (Schedule 9 D)
Bills Payable Government Securities
Unpaid Taxes Other Stocks and Bonds
Real Estate Indebtedness (Schedule C) Debtors
Other Liabilities (item wise) Real Estate
______________________________ Cash Surrender Value for Life Policy
______________________________ Motor Vehicle
 ______________________________ Investment in Business
Net Worth: Other(Item wise):
Total: Total:
Annual Income Annual Expenditure/Payments
Profit From Business
Salary Wife Loan Payments- Mortgages
Dividends or interest Loan Others (Specify)
Rent
Other Income - Details Tax Payments
Agriculture Rates
_______________________________ Premium
_______________________________ Other Expenditure: Home
_______________________________ (Details) ______________________
  _____________________________
Total Total
Net Available For Domestic Expenditure  
1. PARTICULARS OF PERSONAL BANK ACCOUNT :

2. DATE UP TO WHICH INCOME TAXES SETTLED:

3. CONTINGENT LIABILITIES:
a. AS ENDORSER, CO-MAKER OR GUARANTOR:
b. ON LEASES OR CONTRACTS:
c. LEGAL CLAIMS:
d. OTHER SPECIAL DEBTS:
e. AMOUNT OF CONTESTED INCOME TAX:

4. GIVE DETAILS OF ASSETS PLEDGES, HYPOTHECATED OR LOANED:

5. DETAILS OF BUSINESS CONNECTIONS:
6. ARE THERE ANY SUITS OF JUDGMENT AGAINST YOU:
7. HAVE YOU GONE THROUGH BANKRUPTCY OR COMPROMISED A DEBT? :

NAME OF BANK OR FINANCE COMPANIES WHERE CREDIT HAS BEEN OBTAINED (Schedule A)
Secured Or
Name and Address of the institution Date High Credit Owed Currently
Unsecured
– – – – –
– – – – –
– – – – –

SCHEDULE OF LIFE INSURANCE CARRIED INCLUDING LIFE, PERSONAL , SICKNESS ETC. (Schedule B)
Cash Surrender Loans
Name of Company Amount Beneficiary
Value
– – – – –
– – – – –
– – – – –

REAL ESTATES (Schedule C)

Date Title In Name Mortgage To Whom Market
Address & Tenure
Acquired Of Amount Payable Value

SCHEDULE OF STOCKS, BONDS AND SECURITIES (Schedule D)

Current Market Estimated Value
No of Shares / Amount of Bonds Description Cost
on listed on unlisted

The undersigned certifies that both sides hereof and the information furnished thereon is true and correct..

Signature Date Signed

(If Additional Space Required For Any Item Please Use Blank Sheets To Summarize)