Form SBA FORM 770 SBA FORM 770 FINANCIAL STATEMENT OF DEBTOR

Major bills owed (medical, legal, etc.)

Net Worth
SBA FORM 770 (11-11) SOP 50 51 PREVIOUS EDITION OBSOLETE

$1000

Under the provisions of the Privacy Act, loan applicants are not required to give their social security number. The Small Business Administration, however, uses the
social security number to distinguish between people with a similar or the same name. Failure to provide this number may not affect any right, benefit or privilege to
which an individual is entitled by law but having the number makes it easier for SBA to more accurately identify to whom adverse credit information applies and to
keep accurate loan records.
Any Person concerned with the collection of this information, its voluntariness, disclosure or routine use under the Privacy Act may contact the Freedom of Information/
Privacy Acts Office, Small Business Administration, 409 3rd St., S.W., Washington, D.C. 20416
By signing below, I certify that all statements made in this form, and all information provided with this form, are true and correct, I understand that SBA
and my lender are replying on this information, and that false statements can lead to criminal prosecution under 18 U.S.C. 1001 and other laws, with fines of
up to $500,000 and imprisonment up to 10 years, and civil fraud damages of three times the government's loss.

SBA FORM 770 (11-11) SOP 50 51 PREVIOUS EDITION OBSOLETE

Purpose: The primary purpose for collecting this information is to evaluate your ability to pay your loan debt in full or in a compromise settlement. Proving the requested
information is voluntary. However, if the information is not provided, SBA has the right to pursue immediate and full payment of the debt. Routine uses of the information
are established in SBA's Privacy Act System of Record, SBA 21, Loan System last published on April 1, 2009, at 74 FR 14889, 14912.
Instruction: Forms are to be submitted to the SBA loan servicing center that is handling your loan.

Please NOTE: The estimated burden for completing this form is 1 hour 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 (3245-0012). PLEASE DO NOT SEND FORMS TO OMB.
SBA FORM 770 (11-11) SOP 50 51 PREVIOUS EDITION OBSOLETE