Net Worth

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Networth as on ….

Category Assets Name of the Name of the Name of the


applicant 1 applicant 2 applicant 3

Liquid Asset Jewellery


Cash & Bank Balance

Investment in PPF/LIC/Mutual Fund


(Refre to Annexure 1)
Investment in Shares ( Refer to
annexure 2 for listed and unlisted
shares)

Others - please specify and given


details in annexure if required

Total Liquid Assets (I)

Fixed Assets (refer to Annexure 3 for


Fixed Assets details)

Others - please specify and given


details in annexure if required
Total Fixed Assets (II)

Investment in business

Others - please specify and given


Investments
details in annexure if required

Total Investments (III)

Total Assets (IV)=(I)+(II)+(III)

Current libility - Refer to Annexure 4 for


Liabilities (V) repayment terms
Long-term liability - Refer to Annexure
4 for repayment terms
Total liabilities (IV)
Total Networth (IV)-(V)
( INR in lakhs )

Total

0.00

0.00

0.00
Net worth certificate of…… as on….

Annexure 1 - Break-up of LIC/PPF/Mutual fund

Value (INR in lakhs)


Name of Name of Name of
Sl. No Name of the Remarks the the the
investment applicant applicant applicant
1 2 3

Total 0 0 0
Net worth certificate of…… as on….

Annexure 2 - Break-up of shares held

A Shares in listed entity


Value (INR in lakhs)

Name of the Name of the Name of the


Sl. No Name of the entity No. of shares
applicant 1 applicant 2 applicant 3

Total of A 0 0 0

B Shares in unlisted entity


Value (INR in lakhs)

Sl. No Name of the entity No. of shares Name of the Name of the Name of the
applicant 1 applicant 2 applicant 3

Total of B 0 0 0

Total of A and B 0 0 0
Net worth certificate of…… as on….

Annexure 3 - Break-up of fixed assets

Value (INR in lakhs)


Whether the Current
Purpose for What value at
Nature of the fixed asset is Date of outstanding
Sl. No which which it is
assets mortgaged? Mortgage towards
currently used mortgaged?
(Y/N) mortgage

Total 0 0
Value (INR in lakhs)
Name of Name of Name of
the the the
applicant applicant applicant
1 2 3

0 0 0
Net worth certificate of…… as on….

Annexure 4 - Break-up of loan liability

Type of loan
Current/ (housing Repayment
Sl. No. Name of the bank/Financial institutions Long-
loan/vehicle terms
term?
loan etc)
Value of liability as
on the date of net-
worth certificate
(INR in lakhs)

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