Form NIL10 Notice of Insured Loan

IA Form NIL10
Revised X 202X

OMB Control No. 1076-0020
Expires: X/XX/202X

Notice of Insured Loan

(Using this form is optional, but it complies with 25 CFR § 103.18(b).

Lender:_______________________________________
Address:______________________________________
______________________________________
______________________________________
______________________________________
Borrower:_____________________________________
Address:______________________________________
______________________________________
______________________________________
______________________________________

The Lender hereby notifies the United States Department of the Interior (“Department”) that the Lender has
extended a loan to the Borrower pursuant to Department Loan Insurance Agreement number
______________ (the “Agreement”), 25 U.S.C. §§ 1481 et seq., and 25 CFR Part 103, the Indian Loan
Guarantee, Insurance and Interest Subsidy Program (the “Program”). The Lender intends for the Department
to insure the loan in accordance with the Agreement and the Program, and provides the following information
to comply with Agreement and Program requirements:
Original loan principal amount: $____________________________
(Exclusive of amounts potentially added pursuant to 25 CFR §§ 103.8, 103.34, or 103.36.)

Lender’s internal loan number: _______________________________
Interest rate: ☐ Fixed at _____%
☐ Variable at _____% over the prime rate announced by ________________________
________________________________________________________ from time to time.
Loan term (the period over which the loan is to be repaid): ______________________________________
Payment schedule (specify number of payments, due dates, maturity, and any special terms such as periods of
interest only payment or periodic paydown requirements for a revolving loan): _________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Date on which the loan closed:

___________________, 20___

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IA Form NIL10
Revised: X, 202X

OMB Control No. 1076-0020
Expires: _X/XX/202X

If the loan was not fully funded on the date it closed, please explain here: ____________________________
_____________________________________________________________________________________
The Borrower is a(n):
☐ individual Indian
☐ partnership under _________________ law
☐ limited partnership under _________________ law
☐ corporation under _________________ law
☐ limited liability company under _________________ law
☐ Indian tribe
☐ Alaska Native Corporation
☐ Indian tribal enterprise (name tribe and reference organizational resolutions or other
source of authority for enterprise) _____________________________________________
________________________________________________________________________
☐ other (specify kind of organizational structure and source of legal authority) __________
____________________________________________________________________________
Premium due (1% of the insured portion of the original loan principal amount): $______________________
Is the Department’s loan insurance premium payment enclosed?
☐ Yes
☐No (please explain): ____________________________________________________
Lender:______________________________
ABA No.: ____________________________
By:__________________________________
Its:__________________________________
Paperwork Reduction Act Statement: This form is covered by the Paperwork Reduction Act. It is used to notify the Federal
government of a contingent liability. . The information is provided by respondents to obtain or retain a benefit. In compliance
with the Paperwork Reduction Act of 1995, as amended, the collection has been reviewed by the Office of Management
and Budget and assigned a number and an expiration date. The number and expiration date are at the top right corner of
the form. An agency may not sponsor or conduct, and a person is not required to respond to, a request for information

collection unless it displays a currently valid OMB Control Number. The public reporting burden is estimated to average ½

hour per respondent. This includes the time needed to understand the requirements, gather the information, complete the

form, and submit it to the Department. Comments regarding the burden or other aspects of the form may be directed to
the Indian Affairs Information Collection Clearance Officer, Office of Regulatory Affairs – Indian Affairs, 1001 Indian School
Road NW, Suite 229, Albuquerque, New Mexico 87104.

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IA Form NIL10
Revised: X, 202X

OMB Control No. 1076-0020
Expires: _X/XX/202X

Privacy Act Statement (5 U.S.C. 552(a)): The authority for collecting this information is 25 U.S.C. 1511. The

information will be used to administer the Loan Guarantee, Insurance and Interest Subsidy Program, 25 U.S.C. 1481 et seq.
Disclosures of this information may be made to track and record payments and unpaid balances and provide information

on payments made for paying interest subsidy, credits obtained, service loans made, and premiums paid by Lenders,
and for the other routine uses described by system of record notice, BIA-13, Loan Management and Accounting System.

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