
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.