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Certificate as to Partners (United States)

This is a Small Business Administration (SBA) certificate of general partners. The form provided here is simply a sample of what the actual Form 172 looks like.

SMALL BUSINESS ADMINISTRATION
TRANSACTION REPORT ON LOAN SERVICED BY LENDER

1. Mail To:

SMALL BUSINESS ADMINISTRATION
DENVER, CO 80259

2. Lender's Name and Address

_____________________________

_____________________________

_____________________________

3. Loan Number _____________________________

4. Borrower's Name _____________________________

5. Interest Rates SBA _____________________________

Lender _____________________________

6. Percent Shares SBA _____________________________

Lender _____________________________

7. Date Repayment Received _____________________________

8. Installment Due Date Paid _____________________________

9. Interest Period Paid From: ______________ To: _____________

10. No. of Days Interest _____________________________

11. Application of Repayment:

Repayment Amount

TOTAL $_____________________________

LENDER SHARE $_____________________________

SBA SHARE $_____________________________

a. To Interest

TOTAL $_____________________________

LENDER SHARE $_____________________________

SBA SHARE $_____________________________

b. To Principal

TOTAL $_____________________________

LENDER SHARE $_____________________________

SBA SHARE $_____________________________

c. Less: Service Fee *

TOTAL $_____________________________

LENDER SHARE $_____________________________

SBA SHARE $_____________________________

d. Amount Remitted to SBA

TOTAL $_____________________________

LENDER SHARE $_____________________________

SBA SHARE $_____________________________

* Compute Service Fee as follows:

Multiply SBA's Share of Beginning Principal Balance by:
(Number of Days Interest times Daily Factor).
Daily Factor = .0000068 if SBA's Percent Share Exceeds 75%
Daily Factor = .0000103 if SBA's Percent Share is 75% or less.

12. Principal Loan Balance:

a. Last Report (_____________________________)

TOTAL $_____________________________

LENDER SHARE $_____________________________

SBA SHARE $_____________________________

b. Plus Principal Additions

TOTAL $_____________________________

LENDER SHARE $_____________________________

SBA SHARE $_____________________________

c. Less Repayments/Credits

TOTAL $_____________________________

LENDER SHARE $_____________________________

SBA SHARE $_____________________________

d. Ending Balance This Report

TOTAL $_____________________________

LENDER SHARE $_____________________________

SBA SHARE $_____________________________

13. Comments:

_____________________________

_____________________________

14. - - - - - - - OFO USE ONLY - - - - - - -

T/C _____________________________ Offline Code _____________________________

Next Due Date _____________________________

15. Signature and Title _____________________________

16. Telephone No. _____________________________

17. Report Date _____________________________


PLEASE NOTE: The estimated burden hours for the completion of this form is 10 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, 409 3rd St., S. W. Washington, D.C. 20416 and OMB Clearance Officer, Paperwork Reduction Project (3245-0131), Office of Management and Budget, Washington, D.C. 20503.

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