of 4 00049414 200106 The Standa r d Bank o f South A f r i ca L i m i ted Reg No 196200073806 Reg i ste r ed Bank Page 1 of 4 ID: 714008
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Slide1
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
Use this form if...a formal balance sheet and profitand loss account have not been prepared
Hierdie vorm is ook beskikbaar in Afrikaans - vorm nommer 00047775
Balance sheet of:i.e Your name or the name of your business
Balance sheet - for an individual or firmConfidential
Bank account details
Bank
Branch
Accoun
t
number
T
ype of account Surety on account of
As at date
Branch
Balance sheet details
Complet
e this section only if you have signed as surety
Monthly income
Salary - self
Tax - PAYE / SITE
T
ota
l income - Total expenditure =Surplus available
Total income
Statement of income and expenditure
R
Total expenditure
Monthly expenditure
Y
Y
Y
Y
M
M
D
D
Allowances in cash
Commissions
Investments
Salar
y
-
spouse
Other (specify)
R
Pension
UIF
Medical aid
Rent
/
Bond payments
Hire purchase instalments
Lease agreements
Loan repayments
Insurance premiums
Life assurance premiums
Electricity and water
Rates and taxes
T
elephones including rentals
Alimony
/
Maintenance
Planned savings
Credit card accounts
Donations
Education - fees, books etc.
Childrens
'
clothing
Groceries
Clothing accounts
Doctor
/
Chemist
Domestic
/
Garden help
Security system
T
ransport (petrol, bus fare, parking etc)
Entertainment
TV rental
/
M-Net
Other (specify)
Other (specify)
Other (specify)
Other (specify)
RSlide2
00049414
2001-06Page
3 of 4T
otal liabilities Ras
at dateYour signatureContingent liabilitiesas Guarantor, Surety or otherwise
Terms of repaymentIn favour of whom
Which institutionI / 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
Y Y Y Y M M D D
Page 2 of 4
00049414 2001-06Amount
T
otal R
Y
Y
Y
Y
Liabilities
Mortgage bondsand/ or amounts
owing under deeds o
f sal
eFor Bank use
only
Name of bondholder / sellerAnnual capital reductionsMaturity Amounts owingdateOwing under instalment sale / lease agreements
To whom owingInstalment amount
Type of loan
Interest rateDate repayable
State br
iefly
the security givenOwing on credit
cardse.g
Master
card, V
isacard, Garage
Card, Woolworths, Truworths,
Edgars
cards,
etc.
Type of card
Name of company
Bills payable Sundry creditors
Liability for income tax
Other liabilities
RandM M D DFarm name / Plot no.Instalment amountLoans from Standard Bankas at dateInterest rateDate repayableInstalment amount
Name of bank /
financial institution
Description
Period
Y
our signatureLoans from other banks / financial institutions(Including insurance companies)
Limit Interest rateInstalment amountListed sharesI
ncluding Unit Trust
investmentsPresent val
ueRandch
g ld ny r year
vees nd
CompanyNumber heldMarket values, ns,
Bank credit balances/
Deposits(specify the name of
the financialinstitution and
type of account)Cash on handState if any assets are encumberedFarm name / Plot no. SizeDistrict / SuburbDate purchased and price paidMunicipal valuationAssetsFixed propertyGi ve parti cul ars of e
a property separate
ly, statinwhether
f
reeh
o
l
d
o
r
l
easeho
an
d
stat
e
i
f
a
f
f
ecte
d
b
y
a
se
r
v
i
tudes
,
us
u
f
ruc
t
o
f
i
duc
i
a
r
y
i
nterests.
Machiner
y
, Plant,
Implements, etc
Spec
i
f
y
i
mportant
i
tems
on
l
y
V
ehicles
Stat
e
make, model and of first registration
Furniture and fittings Other assets
By whom due
Interest rate
Date repayable
LoansIf security held please gi brief details
Life assurance policies Company
Amount
Surrender value less loans
Date issued
Maturity date
Surrender value of Lif e polici
payable to the undersigned a not to any third party
e.g. ant i ques, carpet
jewell ery, stamp coll ectio
coins, etc.
Balance sheet of
Number
If ceded to whom
Trading assets(applicable to firms only)
Investmentse.g Private company etc
Stock in trade
W
ork in progress
Book debts
(Do
not
i
nc
l
ude
Factored
Book
Debts)
Bills receivable
(Do
not
i
nc
l
ude
d
i
scounted
Bills Receivable)Total assets RLess Total liabilities RSurplus / Deficit of assets over liabilities R
Date last assessment paid: