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SBIC

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Forms

SBIC Forms by Topic

SBIC Topics

Licensing / Program Development

Private Capital

SBA Leverage Commitment

SBA Leverage Draws

Financing

Examinations

View SBIC Forms by Number

Licensing / Program Development

  • Selling Documentation to Be Submitted
    • SBA Form 34: Bank Identification:
    • SBA Form 33: Model Letter to Selling Agent, Executed only when refunding maturing debentures, authorizes disbursement of funding proceeds to SBA, or its Agent:
    • SBA Form 159 : Compensation Agreement for Services in Connection with Application:
    • Debit Authorization: Authorizes Bank of New York to collect payments due on debentures by ACH debit from designated account:
  • Draw Application Instructions (Instructions for drawing leverage using an existing SBA leverage commitment.)
    • Leverage Security Instruments (specific to the type of Debenture leverage requested):

      Type of Leverage

      Form

      Standard Debenture

      SBA Form 444c : Debenture Certification Form .

      LMI Debenture

      SBA Form 2163 : 5-Year LMI Debenture Certification Form ; or

      SBA Form 2162 : 10-Year LMI Debenture Certification Form .

      Energy Saving Debenture

      SBA Form 2434 : 5-Year Energy Saving Debenture Certification Form ; or

      SBA Form 2433 : 10-Year Energy Saving Debenture Certification Form.

      Early Stage Debenture

      SBA Form 2432 : Early Stage Discount Debenture Certification Form ; or

      SBA Form 2435 : Early Stage Current Pay Debenture Form .

    • SBA Form 468 – SBIC Financial Report and Statement of No Material Adverse Change
    • Opinion of Counsel

      Type of SBIC

      Form

      Standard and Impact SBICs

      Depends on type of leverage requested:

      § Form 27b: Standard Debenture Opinion of Counsel

      § Form 27c: LMI Debenture Opinion of Counsel

      § Form 27f: Energy Saving Debenture Opinion of Counsel

      Early Stage

      § Form 27e: Early Stage Discount Debenture Opinion of Counsel

      § Form 27d : Early Stage Current Pay Debenture Opinion of Counsel

Situation

Forms Required

All

  • Form 1031 - Portfolio Financing Report
  • Form 480 - Size Status Declaration
  • Form 652  - Assurance of Compliance for Nondiscrimination

If you require a small business size determination.

  • Form 355 - Application For Small Business Size Determination

If you are using an Energy Saving Debenture to finance the investment and require a pre-Financing determination of eligibility per CFR §107.610(f)(2).

  • Form 2428 : Financing Eligibility Statement for Usage of Energy Savings Debentures

If you are a Specialized SBIC:

  • Form 1941b : Financing Eligibility Statement - "Social Disadvantage" (For individuals who are not members of a designated group)
  • Form 1941a : Financing Eligibility Statement - "Social Disadvantage" (For individuals who are members of a designated group)
  • Form 1941c : Financing Eligibility Statement - "Economic Disadvantage"

If you are submitting a portfolio company to SBA as a success story.

 

SBA will send the following forms prior to the SBIC’s examination.

  • Disclosure Statement
  • SBA Form 857 : Request for Information Concerning Portfolio Financing by SBICs
  • SBIC Ownership Confirmation:
Groups: