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Amendments to License Application (United States)

This is a Small Business Administration (SBA) amendment to license application. The form provided here is simply a sample of what the actual Form 415C looks like.



This form is mandatory. See SBA Policy and Procedural Release #2001, Revised July 1989.


General: (See sections 107.102, 107.601 and 107.1004 of the Regulations.) All Amendments to SBA Form 415 and SBA Form 415A must be submitted under cover of this SBA Form 415C. In case of resignations of officers or directors, a complete Part II, Item 4 (of SBA Form 415) need not be submitted unless the addition of a new officer, director, partner or 10% or more owner is also being reported. In submitting Amendments, it is not necessary to submit items which are not being amended.

Licensees should when submitting Amendments, number the item being amended in accordance with SBA Form 415.

Where to File: Amendments to a License Application, SBA Form 415, should be submitted in duplicate to the SBA, Investment Division, Washington, D.C. 20416.

Date of this Amendment _____________________________

Date of last Amendment Filed _____________________________

Name of Licensee _____________________________

License Number _____________________________

Number of Items being amended _____________________________

Number of pages attached _____________________________

Captions of items being amended _____________________________

Using additional pages attached to this form, set forth in full the Amendments being filed.

The Licensee hereby certifies that all information submitted in this SBA Form 415C and in the pages attached thereto is true and correct and that it is being submitted for the purpose of obtaining approval by SBA of Amendments to Licensee's License

Corporate Seal

By: _____________________________ (Signature)

_____________________________ (Typed Name)

_____________________________ (President of corporate Licensee or General Partner of Unincorporated Licensee)


_____________________________ (Secretary of Corporate Licensee or Equivalent Officer of Unincorporated Licensee)

Dated this day of _____________________________, 20_____

Under the Privacy Act (5 U.S.C. 552a) requests for information amending SBA Form 415A about another party may be denied unless SBA has the written permission of the individual to release the information to the requesters or unless the information is subject to disclosure under the Freedom of Information Act. Note: any person concerned with the collection of information, its voluntariness, disclosure or routine use under the Privacy Act or requesting information under the Freedom of Information Act may contact the Director, Freedom of Information/Privacy Acts Division, Small Business Administration, Washington, D.C. 20416, for information about the Agency's procedures on these two subjects.

PLEASE NOTE: The estimated burden hours for the completion of this form is 15 minutes per response. If you have any questions or comments concerning this estimate or any other aspect of this information collection please contact, Chief Administrative Information Branch, U.S. Small Business Administration, Washington, D.C. 20416 and Gary Waxman, Clearance Officer, Paperwork Reduction Project (3245-0083), Office of Management and Budget, Washington, D.C. 20503.

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