Paycheck Protection Program 

Lender’s Application - Second Draw Loan Guaranty 

Revised March 18, 2021 

OMB Control No.: 3245-0417 

Expiration Date: 9/30/2021 

The purpose of this form is to collect identifying information about the Lender, the Applicant, the loan guaranty request, sources and uses of funds, the 

proposed structure (which includes pricing and the loan term), and compliance with SBA Loan Program Requirements. This form reflects the data fields 

that will be collected electronically from lenders; no paper version of this form is required or permitted to be submitted. As used in this application, 

“Paycheck Protection Program Rules” refers to the rules in effect at the time you submit this application that have been issued by the Small Business 

Administration (SBA) and the Department of the Treasury implementing the Paycheck Protection Program, including Second Draw Paycheck Protection 

Program Loans, under Division A, Title I of the Coronavirus Aid, Relief, Economic Security Act and Economic Aid to Hard-Hit Small Businesses, 

Nonprofits, and Venues Act, and Title V of the American Rescue Plan Act of 2021. 

Instructions for Lenders 

All Second Draw Paycheck Protection Program (PPP) Loans are processed by all Lenders under delegated authority from SBA. This application must be 

submitted and signed electronically in accordance with program requirements, and the information requested is to be retained in the Lender’s loan file. 

A. Lender Information 

Lender Name: Lender Location ID: 

Address: City: St: Zip: 

Lender Contact: Ph: ( ) - Cell or Ext: ( ) -

Contact Email: _______________________________________________ Title: _______________________________________________ 

B. Applicant Information (All Applicant Ownership information provided by the Applicant on the 2483-SD or 2483-SD-C must also be submitted 

electronically) Applicant 

Check One:  Sole proprietor  Partnership  C-Corp  S-Corp  LLC  Independent contractor 

 Self-employed individual  501(c)(3) nonprofit 501(c)(6) organization 

 Single member LLC (self-employed individual)  Qualified joint venture (self-employed individual) 

 501(c)(19) veterans organization  Other 501(c) organization  Housing cooperative  Tribal business 

 Other _________________________ 

Applicant Legal Name: NAICS Code: 

DBA or Tradename (if applicable): Business Tax ID: 

Year of Establishment (if applicable): Number of Employees: 

Applicant Street Address (no 

P.O. Box Addresses Allowed): City, State, Zip: 

Applicant Primary Contact: Phone: ( ) -

SBA Loan Number for First Draw PPP Loan : 

Reduction in Gross Receipts of at 

Least 25% (must provide for loans of 

more than $150,000; provide for 

loans of $150,000 or less ONLY if 

Applicant provided documentation 

and lender performed good faith 

review): 

2020 Quarter: 

Gross Receipts $ 

Reference Quarter: 

Gross Receipts: $ 

Complete this line only if Applicant 

submitted SBA Form 2483-SD-C: 

Total Gross Income (from IRS Form 1040, Schedule C, Line 7) 

$ 

Tax Year Used for Gross Income 

2019 

 2020 

C. Loan Structure Information 

Amount of Loan Request: $ Guarantee %: 100% Loan Term in # of Months: 60 Payment: Deferred 

Applicant must provide documentation to Lender supporting how the loan amount was calculated in accordance with the Paycheck Protection 

Program Rules, and Lender must retain all such supporting documentation in Lender’s file. 

Interest Rate: 1% (calculated on a non-compounding, non-adjustable basis) 

D. Loan Amount Information 

Average Monthly Payroll multiplied by 2.5 (or multiplied by 3.5 for NAICS 72 applicants) 

If Applicant submitted SBA Form 2483-SD-C, use the amount entered in B in either table, plus the 

amount entered in C for Applicants with employees (if applicable), multiplied by 2.5 (or multiplied by 

3.5 for NAICS 72 applicants) 

$ 

Total (may not exceed $2,000,000) $ 

SBA Form 2484-SD (3/21) 1 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. General Eligibility (If the answer is no to any, the loan cannot be approved) 

• The Applicant has certified to the Lender that (1) it was in operation on February 15, 2020, has not permanently closed, 

and was either an eligible self-employed individual, independent contractor, or sole proprietorship with no employees or 

had employees for whom it paid salaries and payroll taxes or paid independent contractors, as reported on Form(s) 1099-

MISC; (2) current economic uncertainty makes this loan request necessary to support the ongoing operations of the 

Applicant; (3) it received a First Draw Paycheck Protection Program Loan and, before the Second Draw PPP Loan is 

disbursed, will have used the full loan amount (including any increase) of the First Draw Paycheck Protection Program 

Loan only for eligible expenses; (4) the funds will be used to retain workers and maintain payroll, or make payments for 

mortgage interest, rent, utilities, covered operations expenditures, covered property damage costs, covered supplier costs, 

and covered worker protection expenditures. 

 Yes  No 

• The Applicant has certified to the Lender that it has realized a reduction in gross receipts in excess of 25% relative to the 

relevant comparison time period. For loans greater than $150,000 (or if the loan is $150,000 or less and the Applicant 

provides documentation of revenue reduction with its application), the Applicant has provided documentation to the Lender 

substantiating the decline in gross receipts and the Lender has confirmed the dollar amount and percentage of the 

Applicant’s decline in gross receipts by performing a good faith review, in a reasonable time, of the Applicant’s calculations 

and of the gross receipts documentation provided by the Applicant. For loans of $150,000 or less that have not provided 

documentation, the Applicant has certified to the Lender that it will provide documentation substantiating the decline in 

gross receipts upon or before seeking loan forgiveness or upon SBA request. 

 Yes  No

• The Applicant has certified to the Lender that the Applicant, together with its affiliates (if applicable), (1) is an independent 

contractor, self-employed individual, or sole proprietor with no employees; (2) employs no more than 300 employees; (3) if 

NAICS 72, employs no more than 300 employees per physical location; (4) if a news organization that is majority owned or 

controlled by a NAICS code 511110 or 5151 business, a nonprofit public broadcasting entity with a trade or business under 

NAICS code 511110 or 5151, or an Internet-only news or periodical publisher assigned NAICS code 519130 and engaged 

in the collection and distribution of local or regional and national news and information, employs no more than 300 

employees per location; or (5) if a 501(c)(3) organization, an eligible 501(c)(6) organization, other eligible 501(c) 

organization, or eligible destination marketing organization, employs no more than 300 employees per physical location. 

 Yes  No

• The Applicant has certified to the Lender that (1) it has not been approved for a Shuttered Venue Operator (SVO) grant 

from SBA as of the date of the loan application, and acknowledged that if the Applicant is approved for an SVO grant 

before SBA issues a loan number for the loan, the Applicant is ineligible for the loan and acceptance of any loan proceeds 

will be considered an unauthorized use; (2) the President, the Vice President, the head of an Executive department, or a 

Member of Congress, or the spouse of such person as determined under applicable common law, does not directly or 

indirectly hold a controlling interest in the Applicant, with such terms having the meanings provided in Section 322 of the 

Economic Aid to Hard-Hit Small Businesses, Nonprofits, and Venues Act; (3) the Applicant is not an issuer, the securities 

of which are listed on an exchange registered as a national securities exchange under section 6 of the Securities Exchange 

Act of 1934 (15 U.S.C. 78f); (4) the Applicant is not a business concern or entity (a) for which an entity created in or 

organized under the laws of the People’s Republic of China or the Special Administrative Region of Hong Kong, or that has 

significant operations in the People’s Republic of China or the Special Administrative Region of Hong Kong, owns or 

holds, directly or indirectly, not less than 20 percent of the economic interest of the business concern or entity, including as 

equity shares or a capital or profit interest in a limited liability company or partnership; or (b) that retains, as a member of 

the board of directors of the business concern, a person who is a resident of the People’s Republic of China; (5) the 

Applicant is not required to submit a registration statement under section 2 of the Foreign Agents Registration Act of 1938 

(22 U.S.C. 612); and (6) the Applicant is not a business concern or entity primarily engaged in political or lobbying 

activities, including any entity that is organized for research or for engaging in advocacy in areas such as public policy or 

political strategy or otherwise describes itself as a think tank in any public documents. 

 Yes  No

• The Applicant has certified to the Lender that the Applicant has not and will not receive another Second Draw Paycheck 

Protection Program Loan.  Yes  No

F. Applicant Certification of Eligibility (If not true, the loan cannot be approved) 

• The Applicant has certified to the Lender that the Applicant is eligible under the Paycheck Protection Program Rules.  True 

G. Franchise/License/Jobber/Membership or Similar Agreement (If a franchise and not listed in the SBA Franchise Directory, the loan 

cannot be approved) 

• The Applicant has represented to the Lender that it is a franchise.  Yes  No 

• The Applicant has represented that the franchise is listed in SBA’s Franchise Directory.  Yes  No 

• If Yes, enter the SBA Franchise Identifier Code here: _______________ 

H. Character Determination (If no, the loan cannot be approved) 

• The Applicant has represented to the Lender that neither the Applicant (if an individual) nor any individual owning 20% or 

more of the equity of the Applicant is presently incarcerated or, for any felony, presently subject to an indictment, criminal 

information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction. 

 Yes  No 

• The Applicant has represented to the Lender that neither the Applicant (if an individual) nor any owner of the Applicant has 

within the last 5 years, for any felony involving fraud, bribery, embezzlement, or a false statement in a loan application or 

an application for federal financial assistance: 1) been convicted; 2) pleaded guilty; 3) pleaded nolo contendere; or 4) 

commenced any form of parole or probation (including probation before judgment). 

 Yes  No

SBA Form 2484-SD (3/21) 2 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I. Prior Loss to Government/Delinquent Federal Debt (If no, the loan cannot be approved) 

• The Applicant has certified to the Lender that neither the Applicant nor any owner is presently suspended, debarred, 

proposed for debarment, declared ineligible, voluntarily excluded from participation in this transaction by any Federal 

department or agency, or presently involved in any bankruptcy. 

 Yes  No 

• The Applicant has certified to the Lender that neither the Applicant nor any of its owners, nor any business owned or 

controlled by any of them, ever obtained a direct or guaranteed loan from SBA or any other Federal agency (other than a 

Federal student loan made or guaranteed through a program administered by the Department of Education) that is (a) 

currently delinquent or (b) has defaulted in the last 7 years and caused a loss to the government. 

 Yes  No 

J. U.S. Employees (If no, the loan cannot be approved) 

• The Applicant has certified that the principal place of residence for all employees included in the Applicant’s payroll 

calculation is the United States.  Yes  No 

K. Fees (If yes, Lender may not pass any agent fee through to the Applicant or offset or pay the fee with the proceeds of this loan) 

• Has the Lender directly contracted with a third party to assist in the preparation of the loan application or application 

materials, or to perform other services in connection with this loan?  Yes  No 

SBA Certification to Financial Institution under Right to Financial Privacy Act (12 U.S.C. 3401) 

By signing SBA Form 2483-SD or 2483-SD-C, Borrower Application Form in connection with this application for an SBA-guaranteed loan, the 

Applicant certifies that it has read the Statements Required by Law and Executive Orders, which is attached to SBA Form 2483-SD or 2483-SD-C. As 

such, SBA certifies that it has complied with the applicable provisions of the Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) and, pursuant to 

that Act, no further certification is required for subsequent access by SBA to financial records of the Applicant/Borrower during the term of the loan 

guaranty. 

Lender Certification 

On behalf of the Lender, I certify that: 

• The Lender has complied with the applicable lender obligations set forth in paragraphs (h)(2)(i)(A)-(D) of the interim final rule “Paycheck 

Protection Program Second Draw Loans” (issued on January 6, 2021), and any amendments thereto. 

• The Lender has obtained and reviewed the required application (including documents demonstrating qualifying payroll amounts and, if required, 

qualifying gross receipts reduction) of the Applicant and will retain copies of such documents in the Applicant’s loan file. 

• The Lender will register in sam.gov no later than thirty (30) days from the date of the first disbursement of a First Draw PPP Loan or Second Draw 

PPP Loan made by the Lender after January 7, 2021 and will provide SBA with the Lender’s unique entity identifier. 

I certify that: 

• Neither the undersigned Authorized Lender Official, nor such individual’s spouse or children, has a financial interest in the Applicant. 

Authorized Lender Official: 

Signature 

Date: 

Type or Print Name: Title: 

NOTE: According to the Paperwork Reduction Act, you are not required to respond to this collection of information unless it displays a currently valid 

OMB Control Number. The estimated burden for completing this form, including time for reviewing instructions, gathering data needed, and completing 

and reviewing the form is 25 minutes per response. Comments or questions on the burden estimates should be sent to U.S. Small Business 

Administration, Director, Records Management Division, 409 3rd St., SW, Washington DC 20416, and/or SBA Desk Officer, Office of Management and 

Budget, New Executive Office Building, Rm. 10202, Washington DC 20503. PLEASE DO NOT SEND FORMS TO THESE ADDRESSES. 

SBA Form 2484-SD (3/21) 3