Franchise Application Form 2

  • Household Income/Expenditure

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    INCOME

    Total salary/wages:

    Bonus/commissions

    Dividends/interest

    Real estate income

    Other income (specify)



    EXPENDITURE


    Mortgage repayments

    Finance/loan repayments

    Credit card repayments

    Telephone/electricity

    School fees & expenses

    Rates and taxes

    Insurance

    Other expenditure (specify)

    Statement of Assets and Liabilities

    (Please provide details on the following asset verification schedules - schedule numbers in parenthesis)


    ASSETS

    Real Estate – current market value (1)

    Cash on Hand and in financial Institutions (2)

    Net value of business interests (3)

    Shares/bonds/debentures – current market value (4)

    Other assets (5)

    TOTAL ASSETS (A)

    LIABILITIES

    Real Estate & Mortgages (1)

    Notes/Loans payable to Financial Institutions (6)

    Loans payable to friends and relatives (6)

    Other debts and obligations (7)

    TOTAL LIABILITIES (B)

    NET WORTH (A)-(B) =

    Asset Verification Schedules

    (1) REAL ESTATE

    Address & description of Property (residential, rental, vacant)
    1)
    2)
    3)
    Date Acquired
    1)
    2)
    3)
    Title in name(s)
    1)
    2)
    3)

    Original Cost
    1)
    2)
    3)
    Original Mortgage Amount
    1)
    2)
    3)

    Monthly repayments
    1)
    2)
    3)
    Current Market Value
    1)
    2)
    3)
    Current Mortgage Balance
    1)
    2)
    3)
    Net Value
    1)
    2)
    3)

    (2) CASH ON HAND AND IN FINANCIAL INSTITUTIONS

    Name of Financial Institution
    1)
    2)
    3)

    Description of Deposit
    1)
    2)
    3)

    Amount
    1)
    2)
    3)

    Maturity
    1)
    2)
    3)


    (3) BUSINESS INTEREST
    Name of Business

    Description

    Type Partnership Corp. Sole

    Name of all owners

    Relation to Applicant

    % Equity

    Valuation Method

    Net Value



    (4) LISTED SECURITIES

    No. of Shares

    Description

    Current Market Value



    BONDS/ DEBENTURES

    No.

    Description

    Face Value

    Current Market Value

    (5) OTHER ASSETS
    (e.g. stock options, cash value of life insurance, automobiles and other personal
    property etc).

    Description

    Current Fair Market Value



    (6) LOANS/NOTES/ACCOUNTS PAYABLE (excluding mortgages)

    Lender

    Relation to Applicant

    Nature of debt

    Secured yes/no

    Maturity Date

    Original Face Value

    Monthly Repayments

    Interest Rate

    Present Balance





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