Source: https://www.templateroller.com/template/1861640/sba-form-1919-sba-7-a-borrower-information-form.html
Timestamp: 2020-04-06 05:14:24
Document Index: 228973020

Matched Legal Cases: ['§ 120', '§ 121', '§ 120', '§ 105', '§ 1001', '§ 1001', '§ 1014']

SBA Form 1919 Download Fillable PDF or Fill Online SBA 7(A) Borrower Information Form | Templateroller
SBA Form 1919 "SBA 7(A) Borrower Information Form"
SBA Form 1919, SBA 7(a) Borrower Information Form - also referred to simply as the Borrower Information Form - is a form issued by the Small Business Administration (SBA) and used for collecting information about a 7(a) Borrower. The form reports on the Borrower's their indebtedness, their business, and information about any current or previous government financing.
An SBA Form 1919 fillable version is available for download through the link below or can be found through the SBA website. The new SBA Form 1919 was released by the agency in January 2018 with all previous editions obsolete.
The form is mainly used for determining whether the small business is eligible to be provided with a loan and facilitates a background check on the Borrower. The form is required for all businesses applying for a loan through the SBA 7(a) Program or the Community Advantage (CA) Program.
The SBA Form 1920 (Lender's Application for Guaranty) is required to be provided with the Borrower Information Form during the 7(a) loan application process. The SBA 1920 should be filled out by the Lender in order to provide information regarding loan terms, the use of proceeds and other necessary information to the SBA.
Download SBA Form 1919 PDF
SBA Form 1919 Instructions
How to Fill out SBA Form 1919?
The SBA 7(a) Loan Guarantee Program is one of the most well-known loan programs offered by the SBA. The program is designed to help small businesses get access to funding. The maximum sum a Borrower may request is a $2 million loan for 25 years for purchasing real estate and equipment for business use or 7 years for working capital.
The SBA does not lend money directly to the small businesses, it only guarantees the loan for the bank, acting as a co-signer. The Borrower can choose the Lender that best suits their demand. All paperwork required by the SBA is completed through the Lender. To be considered eligible for the SBA 7(a) Loan Program, the business has to operate for profit within the United States and meet SBA's small size standards. The size of the business is determined by the number of employed personnel and the average loan receipts. Non-eligible businesses include lending companies, companies that engage in illegal or speculative activities and non-profit organizations.
All small business owners who proceed with the 7(a) application are required to complete the SBA Borrower Information Form. The following categories of Borrowers are required to file the SBA 1919:
All general partners and all limited partners who own 20% of the business or more;
All individuals who own 20% or more of a corporation;
All directors, managers or members of staff owning 20% or more of an LLC;
Any individual hired by the small business to manage day-to-day operations.
Section I requires the information about the small Borrower's lending history and needs to be filled out by an authorized representative of the applicant business (in most cases - the president or the majority owner of a business). This section also requires the requested loan amount, its purpose, and the amount of the last tax return. Section I should also contain information about the operating licenses, agreements, and branch offices of the applicant business, the ownership stake and contact information of all equity owners and the staff headcount.
Section II requires information related to the principals of a business and includes questions about the Borrower's criminal and professional records, personal obligations, citizenship, and business history.
The final part of the form verifies all of the information provided above. The completed SBA Form 1919 should be submitted to the Lender who will forward all paperwork to the SBA.
Download SBA Form 1919 "SBA 7(A) Borrower Information Form"
For use with all 7(a) Programs
The purpose of this form is to collect information about the Small Business Applicant (“Applicant”) and its principals, the loan
request, indebtedness, information about current or previous government financing, and certain other topics. The information also
facilitates background checks as authorized by section 7(a)(1)(B) of the Small Business Act, 15 U.S.C. 636(a)(1)(B). This form is to
be completed by the Applicant and all individuals identified below and submitted to your SBA Participating Lender. Submission of
the requested information is required for SBA or the Lender to make a determination regarding eligibility for financial assistance.
Failure to submit the information would affect that determination.
This form is divided into two sections. Section I requests information about the Small Business Applicant and must be completed in its
entirety, signed and dated by an authorized representative of the Small Business Applicant that is requesting a business loan. A
separate Section I is required to be completed and signed for each co-applicant (e.g. “Eligible Passive Company (EPC)”or
“Operating Company (OC)”).
Section II of this form requests information about each of the Small Business Applicant’s principals. This section must be completed
in its entirety, signed and dated by the following:
For a partnership, all general partners, and all limited partners owning 20% or more of the equity of the firm; or any partner that is
involved in management of the applicant business;
For a corporation, all owners of 20% or more of the corporation, and each officer and director;
For limited liability companies, all members owning 20% or more of the company, each officer, director, and managing member;
Any Person hired by the business to manage day-to-day operations (“key employee”); and
Any Trustor (if the Small Business Applicant is owned by a trust).
All parties listed above are considered “Associates” of the Small Business Applicant as defined in 13 CFR § 120.10, as well as
“principals.” A separate Section II is required to be completed and signed by each principal of the Small Business Applicant.
For clarification regarding any of the questions, please contact your Lender.
Affiliation – Concerns and entities are affiliates of each other when one controls or has the power to control the other, or a
third party (or parties) controls or has power to control both. For example, affiliation may arise through ownership,
common management (including through a management agreement), or when there is an identity of interest between close
relatives with identical, or substantially identical, business interests. The complete definition of “affiliation” is found at 13
CFR § 121.301(f).
Close Relative - Close Relative is a spouse; a parent; or a child or sibling, or the spouse of any such person.
Eligible Passive Company (“EPC”) – is a small entity or trust which does not engage in regular and continuous business
activity which leases real or personal property to an Operating Company for use in the Operating Company’s business, and
which complies with the conditions set forth in 13 CFR § 120.111.
Household Member – A “household member” of an SBA employee includes: a) the spouse of the SBA employee; b) the
minor children of said individual; and c) the blood relatives of the employee, and the blood relatives of the employee’s
spouse who reside in the same place of abode as the employee. [13 CFR § 105.201(d)]
Operating Company (“OC”) – is an eligible small business actively involved in conducting business operations now or
about to be located on real property owned by an Eligible Passive Company, or using or about to use in its business
operations personal property owned by an Eligible Passive Company.
SBA Form 1919 (01/18)
(Section I: Applicant Business Information)
OC /  EPC)
Applicant Business Legal Name (
Applicant Business Primary Business Address
Applicant Business Tax ID
Applicant Business Phone
Project Address (if other than primary business address)
# of existing employees employed by business? (including owners):
# of jobs to be created as a result of the loan? (including owners):
# of jobs that will be retained as a result of the loan that otherwise would have been lost? (including owners):
List all proprietors, partners, officers, directors, and holders of outstanding stock. 100% of ownership must be reflected. Attach a separate sheet if
necessary. Based on this form’s instructions not all owners will need to complete the Principal Information section of this form.
Unless stated otherwise, if any of the questions below are answered “Yes,” please provide details on a separate sheet.
Are there co-applicants? (If “Yes,” please complete a separate Section I: Applicant Business Information for each.)
Has an application for the requested loan ever been submitted to the SBA, a lender, or a Certified Development Company, in
connection with any SBA program? (If “Yes,” provide details on a separate sheet.)
Is the Small Business Applicant presently suspended, debarred, proposed for debarment, declared ineligible, or voluntarily
excluded from participation in this transaction by any Federal department or agency?
Does the Small Business Applicant operate under a Franchise/License/Distributor/Membership/Dealer/
Jobber or other type of Agreement? (If “Yes,” provide copies of your agreement(s) and any other relevant documents.)
Does the Small Business Applicant have any Affiliates? (If “Yes,” please attach a listing of all Affiliates.)
Has the Small Business Applicant and/or its Affiliates ever obtained a direct or guaranteed loan from SBA or any other Federal
agency or been a guarantor on such a loan?
If you answered “Yes” to Question 8, is any of the financing currently delinquent?
If you answered “Yes” to Question 8, did any of this financing ever default and cause a loss to the Government?
Are any of the Small Business Applicant’s products and/or services exported or is there a plan to begin exporting as a result of
If ”Yes,” provide the estimated total export sales this loan will support: $
10 Is the Small Business Applicant using (or intending to use) a packager, broker, accountant, lawyer, etc. to assist in (a) preparing
the loan application or any related materials and/or (b) referring the loan to the lender?
11 Are any of the Small Business Applicant’s revenues derived from gambling, loan packaging, or from the sale of products or
services, or the presentation of any depiction, displays or live performances, of a prurient sexual nature?
SBA may not provide financial assistance to an applicant where there is any appearance of a conflict of interest with an SBA or other
governmental employee. With the exception of question 15, if any of the questions below are answered “False,” this application may not be
submitted under any delegated processing method, but must be submitted to the LGPC for non-delegated processing. Note: This does not mean
that your loan will be denied, only that your lender will need to use different SBA procedures to process this loan. If the answer to question 15 is
“no,” the application may be processed under a lender’s delegated authority only after the lender received clearance from SBA.
12 No SBA employee, or the household member (see definition on page 1) of an SBA employee, is a sole proprietor, partner,
officer, director, or stockholder with a 10 percent or more interest, of the Applicant. [13 CFR 105.204]
13 No former SBA employee, who has been separated from SBA for less than one year prior to the request for financial assistance,
is an employee, owner, partner, attorney, agent, owner of stock, officer, director, creditor or debtor of the Applicant. [13 CFR
105.203]
14 No member of Congress, or an appointed official or employee of the legislative or judicial branch of the Federal Government, is
a sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest, or household member of
such individual, of the Applicant. [13 CFR 105.301(c)]
15 No Government employee having a grade of at least GS-13 or higher is a sole proprietor, general partner, officer, director, or
stockholder with a 10 percent or more interest, or a household member of such individual, of the Applicant. [13 CFR
105.301(a)]
16 No member or employee of a Small Business Advisory Council or a SCORE volunteer is a sole proprietor, general partner,
officer, director, or stockholder with a 10 percent or more interest, or a household member of such individual, of the Applicant.
[13 CFR 105.302(a)]
By Signing Below, You Make the Following Representations and Certifications
I have read the Statements Required by Law and Executive Order included in this form, and I understand them.
I will comply, whenever applicable, with the hazard insurance, lead-based paint, civil rights and other limitations in this
All SBA loan proceeds will be used only for business related purposes as specified in the loan application.
I certify that the information provided in this application and the information that I have provided in all supporting documents and
forms is true and accurate. I realize that the penalty for knowingly making a false statement to obtain a guaranteed loan from SBA is
that I may be fined up to $250,000 and/or be put in jail for up to 5 years under 18 USC § 1001 and if false statements are
submitted to a Federally insured institution, I may be fined up to $1,000,000 and/or be put in jail for up to 30 years under 18 USC §
Signature of Authorized Representative of Applicant Business
(Section II: Principal Information)
Applicant Business:
Tax ID if an Entity
(City & State or Foreign Country)
% of Ownership in the
Small Business Applicant
Veteran/Gender/Race/Ethnicity data is collected for program reporting purposes only.
Disclosure is voluntary and has no bearing on the credit decision.
Enter Response Below
1=Non-Veteran; 2=Veteran; 3=Service-Disabled Veteran; 4=Spouse of Veteran; X=Not Disclosed
M=Male; F=Female; X=Not Disclosed
1=American Indian or Alaska Native; 2=Asian; 3=Black or African-American; 4=Native Hawaiian or
Race (more than 1
Pacific Islander; 5=White; X=Not Disclosed
may be selected)
H=Hispanic or Latino; N=Not Hispanic or Latino; X=Not Disclosed
Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal
criminal charges are brought in any jurisdiction? (If “Yes,” the loan request is not eligible for SBA assistance.)
Initial here to confirm your response to question 17 
Initial here to confirm your response to question 18 
For any criminal offense – other than a minor vehicle violation – have you ever: 1) been convicted; 2) pleaded guilty;
3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been placed on any form of parole or probation
(including probation before judgment)?
Initial here to confirm your response to question 19 
If you answer “Yes” to questions 18 or 19, you must complete SBA Form 912, “Statement of Personal History.” You will need to furnish details,
including dates, location, fines, sentences, level of charge (whether misdemeanor or felony), dates of parole/probation, unpaid fines or penalties,
name(s) under which charged, and any other pertinent information. If you answer “Yes” to question 19 and are currently on parole or probation,
the loan request is not eligible for SBA assistance.
Are you presently suspended, debarred, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency?
If you are a 50% or more owner of the Small Business Applicant, are you more than 60 days delinquent on any
obligation to pay child support arising under an administrative order, court order, repayment agreement between the
holder and a custodial parent, or repayment agreement between the holder and a state agency providing child support
I am a U.S. Citizen OR
I am not a U.S. Citizen or Lawful Permanent Resident
Initial here to confirm your responses to question 22 
Do you have any ownership in other businesses which would be defined as an Affiliate in the definition found on page
1? (If “Yes,” attach a listing of all businesses and your ownership percentage or position in the business.)
Have you, or any business you controlled, ever filed for bankruptcy protection?
Are you, or any business you control, presently involved in any legal action (including divorce)?
Have you or any business owned or controlled by you ever obtained a direct or guaranteed loan from SBA or any other
Federal agency or been a guarantor on such a loan? (This includes student loans.)
(a) If you answered “Yes” to Question 26, is any of the financing currently delinquent?
(b) If you answered “Yes” to Question 26, did any of this financing ever default and cause a loss to the Government?
(If Yes to (a) or (b) above, please provide Lender with a written explanation.)
• I have read the Statements Required by Law and Executive Order and I understand them.
• I will comply, whenever applicable, with the hazard insurance, lead-based paint, civil rights or other limitations in this form.
• All SBA loan proceeds will be used only for business related purposes as specified in the loan application.
• To the extent feasible, I will purchase only American-made equipment and products.
I authorize the SBA to request criminal record information about me from criminal justice agencies for the purpose of determining my
eligibility for programs authorized by the Small Business Act, as amended.
that I may be fined up to $250,000 and/or be put in jail for up to 5 years under 18 USC § 1001 and if false statements are submitted to
a Federally insured institution, I may be fined up to $1,000,000 and/or be put in jail for up to 30 years under 18 USC § 1014.
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