SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire

SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessment Questionnaire

3245-0062 F5-Template.xls

SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire

OMB: 3245-0062

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V1.1.b - May 24, 2006











Exhibit F5 - Miscellaneous Investments











SBIC Applicant/Principal:






















$-




$- $-
$- $-

Enter Total Cash Invested for Company Cash Invested Enter Date(s) of Investment. If investment spans years, enter range, Date(s) Invested Enter the Name of the Company. Company Name Enter the age of the company in years at the time of initial investment. Age of Company (Yrs) Enter the primary industry in which the company operates. Primary Industry Describe the specific products and services of the company in more detail. Description of Products/Services Enter any cash proceeds received from the investment. Cash Proceeds Received from Investment Enter the cost basis of any cash proceeds received. Cost Basis of Cash Proceeds Enter the Date(s) proceeds were received. If received over a span of time, enter the range of dates. Date(s) Proceeds Received Enter the value for the firm's holding in the this company if this company was in the portfolio prior to your arrival. Valuation of Remaining Holdings Enter the cost basis of any remaining holdings. Cost Basis of Remaining Holdings
















































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































File Typeapplication/vnd.ms-excel
AuthorTMJamers
Last Modified ByCBRich
File Modified2007-04-04
File Created2003-11-03

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