FINANCIAL CAPABILITY STATEMENT
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Applicant Information
Available Liquid Funds
Proof of Income
Existing Liabilities
Investment Capacity
Financial Background
Attorney Verification
Applicant Declaration
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Financial Capability Statement
State of San Andreas – City of Los SantosSubmitted to: Office of the Mayor
Prepared by:
Applicant Information (Client Details)
Full Name:
CID:
Date of Birth:
CID:
Date of Birth:
Residential Address:
Phone Number:
Email:
Phone Number:
Email:
Application Purpose:
Financial Overview
Available Liquid Funds
Bank Balance: $
Savings Balance: $
Cash on Hand: $
Other Liquid Assets: $
Total Liquid Funds: $
Existing Liabilities
Loan/Debt: $
Other Liabilities: $
Total Liabilities: $
Bank Balance: $
Savings Balance: $
Cash on Hand: $
Other Liquid Assets: $
Total Liquid Funds: $
Existing Liabilities
Loan/Debt: $
Other Liabilities: $
Total Liabilities: $
Proof of Income
Primary Income Source & Monthly Amount:
Secondary Income Source & Monthly Amount:
Other Income:
Total Monthly Income: $
Investment Capacity
Initial Investment Capability: $
Estimated Monthly Operating Budget: $
Expected Funding Sources:
Primary Income Source & Monthly Amount:
Secondary Income Source & Monthly Amount:
Other Income:
Total Monthly Income: $
Investment Capacity
Initial Investment Capability: $
Estimated Monthly Operating Budget: $
Expected Funding Sources:
Financial Background
Previous Business Experience:
Financial Conduct (Past fraud, etc.):
Previous Business Experience:
Financial Conduct (Past fraud, etc.):
Attorney Verification
I, , verify that I have reviewed my client’s financial records and confirm that the information provided is accurate to the best of my knowledge.
Attorney Signature:
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Date:
I, , verify that I have reviewed my client’s financial records and confirm that the information provided is accurate to the best of my knowledge.
Attorney Signature:
Date:
Applicant Declaration
I, , declare that all information provided is truthful and complete.
Applicant Signature:
![]()
Date:
I, , declare that all information provided is truthful and complete.
Applicant Signature:
Date: