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SAMPLE PROFIT LOSS STATEMENT Any borrower s who is/are self-employed or an independent contractor should complete this form if they do not already have their own profit and loss form. Company Name Percent of Ownership Company Address Type of Business Borrower Name s Loan Number Dates Reported MM/DD/YY - MM/DD/YY Must be minimum of 3 full months Please fill in the fields that apply to your business GROSS INCOME Gross Sales Total amount of income from sales or service before subtracting...
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Do NOT include other expenses. For example expenses for renting, office space, etc). Include sales of business inventory, business equipment, and inventory sales of goods that have not yet been sold. Borrower Type: Business Number: Borrower City, State: Loan Age (Years) Annual Interest Rate (APR) Monthly Income % Interest Paid on Loan (Annual %) Percentage Loss for Period: 1-29 30-39 40-49 50-59 60-69 70-79 80-89 All Borrower's Income (No Exclude: Interests, Taxes, Insurance and Pensions) Percent Owner's Interest Percent Owner's LOSSES Percent Owner's INTEREST Percent Other Losses Average Sale Price % LESS (If less than 25,000) Fewer Losses for period (If less than 1,000,000) Net Profit (If less than 50,000) More Losses for period (If more than 50,000) Loan Status: Regular Monthly Payment (MM/DD/YYY) Monthly Profit (MM/DD/YYY) Loan Length (Years) Loan Principal Amount (Pay Date) (MM/DD/YYY) Net Profit (DD/MM/YYY) Balance as of Loan Ending (MM/DD/YYY) Loan Payment Term (Years) Annual Percentage Rate (APR) Monthly Principal Payment (MM/DD/YYY) Loan Term (Years) Loan Payment Type: Cash, Check, Debit Card, Money Order, PayPal, E-Check, Credit Card. PROFIT & LOSS STATEMENT Any borrower(s) who is/are self-employed or an independent contractor should complete this form if they do not already have their own profit and loss form. Company Name: Percent of Ownership % Company Address: Type of Business: Borrower Name(s): Loan Number: Dates Reported (MM/DD/BY MM/DD/BY) (Must be minimum of 3 full months) Please fill in the fields that apply to your business. PROFIT & LOSS STATEMENT Any borrower(s) who is/are self-employed or an independent contractor should complete this form if they do not already have their own profit and loss form.

Who needs a Profit and Loss Statement form?

Each borrower working for oneself or being an independent contractor should complete this form to summarize the revenues, costs and expenses they had during a particular period, usually a fiscal quarter or year.

What is the Profit & Loss form for?

The Profit and Loss Statement provides information on total expenditure and revenue, to eventually bring the person’s total net income after taxes. This information can be used by a lender to modify loan terms.

Is the Sample Profit and Loss Statement form accompanied by other forms?

Usually, the Profit and Loss Statement is accompanied by the balance sheet (conclusion, showing what is owned and owed at a given time) and the cash flow statement (showing changes in bills over a selected period).

When is Profit & Loss Statement form due?

The minimum period, which may be reflected in the report is three months. Accordingly, it is intended that this report should be submitted by the borrower once a quarter or less often if it has been previously agreed with the creditor.

How to create a Profit and Loss Statement form?

The borrower should provide accurate information about 1) their company and type of business; 2) their basic information; 3) gross info before taxes; 4) expenses; 5) net income. The document should be signed by the borrower(s).

Where do I send Profit and Loss Statement form?

This document, completed and signed, must be directed to the address of the creditor. However, it is necessary to make sure that the copy of the paper remains with the borrower for their personal needs.

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