Date:
Name:
Assets
Non-Farm Assets / Particulars / Present Value / For Bank Use Only
Total Non-Farm Assets
Current Assets / Particulars / Present Value / For Bank Use Only
Cash on hand
Accounts receivable
Inventory: grain (specify amount and type)
Market livestock
Other
Total Current Assets
Fixed Assets Machinery, Vehicles / Make, Size, Model / Year Manufactured / Present Value / For Bank Use Only
Total Fixed Assets
Livestock (Basic Herd) / Description, Brand / Age / Average Weight / Number / Value/Head / Present Value / For Bank Use Only
Total Livestock Assets
Other / Particulars / Present Value / For Bank Use Only
Total Other Assets
Long Term Value of Farm / Particulars / Present Value / For Bank Use Only
Total Long-Term Assets
Total Assets (A)
Liabilities
Current (under 1 Year) Name and Address of Creditors / Loan Purpose / Date of Loan / Length of Loan / Interest Rate % / Repayment Terms / Original Amount / Present Amount Owing / For Bank Use Only
Accounts Payable
Taxes, Water Rates
Operating Loans
Total Current Liabilities
Intermediate (1-10 Years) Name and Address of Creditors / Loan Purpose / Date of Loan / Length of Loan / Interest Rate % / Repayment Terms / Original Amount / Present Amount Owing / For Bank Use Only
Owing on Machinery
Owing on Livestock
Other Intermediate
Total Intermediate Liabilities
Intermediate (> 10 Years) Name and Address of Creditors / Loan Purpose / Date of Loan / Length of Loan / Interest Rate % / Repayment Terms / Original Amount / Present Amount Owing / For Bank Use Only
Owing on Land and Buildings
Other Long-Term
Total Long-Term Liabilities
Total Liabilities (B)
Total Assets (A)
Total Liabilities (B)
Net Worth (A-B)
Prepared By:
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Source: USAID’s Lending to the Agriculture Sector Toolkit – December 2012