Preview Personal Profit And Loss Statement Form

Self Employment Profit & Loss Form

You are required to complete this form for the most recent three months. Submit one summary form for

each of the last three months.

MONTH(S) THIS FORM INCLUDES:

INCOME/GROSS SALES:

 If you pay yourself a salary or take a draw from your business, please provide

copies of your paystubs for the last three months and state the gross amount:

EXPENSES – Enter all that apply:

 Rent/Mortgage of business premises

 Phone/Utilities

 Gross Labor Wages (not for self)

 Business Taxes (not personal income tax payments)

 Loan payments: Principle: $_________ Interest: $_________

Balance:

 Bank Charges

 License Fees Paid

 Legal Fees

 Office Supplies

 Tools/Equipment

 Repairs/Upkeep

 Merchandise/Purchases/Cost of Goods

 Fuel/Gas

 Advertising

 Commissions Paid

 Shipping

 Equipment Rental

 Insurance

Type of Insurance:

 Other Expenses (please list):

TOTAL EXPENSES:

NET INCOME

BUSINESS VEHICLE in your name: Year: _____ Make: ____________ Model: _________

BANK ACCOUNTS – Include dates:

 Balance in business checking account : Date: _________

 Balance in business savings account : Date: _________

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