Form NOD10 Notice of Default

IA Form NOD10
Revised: X 202X

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

NOTICE OF DEFAULT
Department of the Interior Loan Guarantee, Insurance and Interest Subsidy Program
(Using this form is optional, but it complies with 25 CFR § 103.35.)

Department Loan Guarantee Certificate Number ___________
Department Loan Insurance under Loan Insurance Agreement Number ____________

Lender:_______________________________________
Borrower:_____________________________________
Guarantee or Insurance Percentage: _______%
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 Subsidy awarded on loan?
Yes
No

Indicate the earliest date of default, as defined by 25 CFR § 103.44: ____________, 20___
List all bases for default:_________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
If there is a monetary default, list:
1.
the amount of past due principal:
2.
the amount of past due interest:
3.
the amount of any late fees:
4.
the amount of any precautionary advances:
5.
any other amounts the Lender claims:
(Identify authority in space provided below.)

6.

________________
________________
________________
________________
________________

TOTAL:________________

the date through which interest has been calculated:__________, 20__

Indicate the nature and outcome of any correspondence or other contacts with the Borrower concerning
the default (including dates):_____________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

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IA Form ALD10
Revised X 202X

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

Indicate the precise nature of any action the Borrower could take to cure the default:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Indicate any special circumstances concerning this default (e.g., Borrower or a principal or guarantor is
subject to bankruptcy proceedings; explanation for amounts Lender is including in its claim, etc.):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Date: ____________, 20__

Lender:____________________________
By:_______________________________
Its: _______________________________

Note:

The Lender should send the Department this Notice of Default via certified mail (return receipt requested) or by a
nationally-recognized overnight delivery service (signature of recipient required). See 25 CFR § 103.35(b).

Paperwork Reduction Act Statement: This form is covered by the Paperwork Reduction Act. It is used to notify the Federal
government of a potential 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.
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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