Statement of income and expenditure



Statement of income and expenditureMonthly incomeAllowances in cashCommissionsInvestmentsSalary - spouseOther (specify)RSalary - selfUse this form if...a formal balance sheet and profit and loss account have not been preparedBalance sheet - for an individual or firmConfidentialHierdie vorm is ook beskikbaar in Afrikaans - vorm nommer 00047775Total incomeBranch M onthl y expendi ture PensionUIFMedical aidRent / Bond paymentsHire purchase instalmentsLease agreementsLoan repaymentsInsurance premiumsLife assurance premiumsElectricity and waterRates and taxesTelephones including rentalsAlimony / MaintenancePlanned savingsCredit card accountsDonationsEducation - fees, books etc.Childrens' clothingGroceriesClothing accountsDoctor / ChemistDomestic / Garden helpSecurity systemTransport (petrol, bus fare, parking etc)EntertainmentTV rental / M-NetOther (specify)Other (specify)Other (specify)Other (specify)RTax - PAYE / SITE Balance sheet details Balance sheet of:i.e Your name or the name of your businessYYYYMMDDAs at dateComplete this section only if you have signed as surety Bank account details BankBranchAccount numberType of accountSurety on account ofTotal expenditureRTotal income - Total expenditure =Surplus available00049414 2001-06Page 4 of 400049414 2001-06The Standard Bank of South Africa Limited Reg No 1962/000738/06 Registered BankPage 1 of 4Balance sheet ofAssetsState if any assets are encumberedDate purchasedMunicipalPresent valueas at dateYYYYMMDDLiabilitiesFarm name /Name of bondholder /Annual capitalMaturityAmounts owingFixed propertych g ld ny r Gi ve parti cul ars of ea Farm name / Plot no.SizeDistrict / Suburband price paidvaluationRandFor Bank use onlyMortgage bondsand/ or amounts owingPlot no.sellerreductionsdateRandproperty separately, statin whether freehold or leaseho and state if aff ected by a ser v i tudes, usu f ruct o fiduciary interests.Machinery, Plant, Implements, etcSpecify important items onlyunder deeds of saleOwing under instalment sale / lease agreementsTo whom owingInstalment amountyearVehiclesState make, model and of first registrationFurniture and fittingsLoans from Standard BankType of loanInterest rate Date repayableInstalment amounts, ns,Other assetse.g. ant i ques, carpet jewell ery, stamp coll ectio coins, etc.Life assurance policiesCompanyNumberDate issuedMaturity dateAmountIf ceded to whomSurrender value less loansLoans from other banks / financial institutions(Including insurance companies)State briefly theName of bank / financial institutionInterest rate Date repayable Instalment amountes ndSurrender value of Lif e polici payable to the undersigned a not to any third partysecurity givenOwing on credit cardsvee.g Mastercard, Visacard, Garage Card, Woolworths, Truworths, Edgars cards,Date last assessment paid:Type of cardName of companyLimitInterest rate Instalment amountLoansIf security held please gi brief detailsInvestmentse.g Private company etcBy whom dueInterest rateDate repayableetc.Bills payable Sundry creditorsLiability for income taxOther liabilitiesDescriptionPeriodTerms of repaymentListed sharesIncluding Unit Trust investmentsCompanyNumber heldMarket valueTrading assets(applicable to firms only)Contingent liabilitiesas Guarantor, Surety or otherwiseIn favour of whomWhich institutionAmountBank credit balances/ Deposits(specify the name of the financial institution and type of account)Cash on handTotal RTotal liabilities R Your signature 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.YYYYMMDDI / We agree that the bank may verify the information contained in this statement and may make any enquiries it considers necessaryStock in tradeWork in progressBook debts (Do not include Factored Book Debts)Bills receivable (Do not include discounted Bills Receivable)Total assetsRLess Total liabilitiesRSurplus / Deficit of assets over liabilities RYour signatureas at date00049414 2001-06Page 2 of 400049414 2001-06Page 3 of 4 ................
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