SBA FORM 1065 Applicant Licensee's Assurance of Compliance

25-Model Corp. Resol. or GP Certif., 33-Model Letter to Selling Agent, 34-Bank ID, 1065-Appl. Lic. Assure. of Compliance

SBIC SBA Form 1065 11-15

25-Model Corp.. Resol, or GP Certif, 33-Model Letter to Selling Agent, 34-Bank ID, 1065-Appli.Lic. Assur. of Compliance

OMB: 3245-0081

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OMB Approval No.: 3245‑0081

Expiration Date: 11-30-2011







SMALL BUSINESS ADMINISTRATION


APPLICANT LICENSEE'S ASSURANCE OF COMPLIANCE


(Public Interest)



, Applicant Licensee, in consideration of financial assistance from the Small Business Administration, hereby covenants that it will comply with the provisions of Section 107.720(f) of the SBA Regulations.


Section 107.720(f) of the SBA Regulations prohibits the use of funds for purposes contrary to the public interest. SBA Policy and Procedural Release Number 2015 provides guidance to small business investment companies, including Section 301(d) Licensees, regarding such prohibitions and enumerates certain purposes which are contrary to the public interest, including, but not limited to, adverse influences on employment in any area, activities not consistent with free competitive enterprise, operations contributing to water, air, and solid waste pollution, and construction in designated flood hazard areas.


Applicant Licensee further agrees that, in the event it fails to comply with its undertakings hereunder as specified in the cited Regulation and Release, SBA may invoke the remedies set forth in Section 107.1810 or Section 107.1820, as applicable, of the SBA Regulations.


Executed this day of , .




By


Title


Corporate Seal



Attest



[Please execute and file this form, together with the other required documents for the submission of the SBIC debenture commitment application to: U.S. Small Business Administration, Investment Division, Funding Admin. Branch, 409 Third Street, SW, Washington, DC 20416.]


PLEASE NOTE: The estimated burden for completing this form is 12 minutes per response. You are not required to respond to any collection of information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St., S.W., Washington D.C. 20416 and Desk Officer for the Small Business Administration, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503. OMB Approval (3245-0081). Do not Send Forms to OMB.


SBA Form 1065 (11-11)

File Typeapplication/msword
AuthorJohnny A. Kitts
Last Modified ByCBRICH
File Modified2011-11-15
File Created2011-11-15

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