Form SBA Form 1050 SBA Form 1050 Settlement Sheet

OMB Control No: 3245-0200
Expiration Date: xx/xx/xxxx

SBA SETTLEMENT SHEET
FORM 1050
Purpose: The purpose of this form is to document and verify that loan proceeds have been disbursed in
accordance with the Authorization and to document that the Borrower’s contribution has been injected into
the business prior to the Lender disbursing any loan proceeds.
Requirement: Lenders must use this form for the first disbursements on all standard 7(a) loans.

This form is to be completed by the Lender and signed by the Lender and the Borrower at the time of the initial loan
disbursement. If there are subsequent disbursements, Lender must document each disbursement and attach the
documentation to the original SBA Form 1050 (a new SBA Form 1050 is not required for each subsequent disbursement). The
Lender must retain a copy of the signed form in its loan file. For all disbursements, the Lender must also retain documentation
that is acceptable to SBA (such as joint payee checks, cancelled checks, paid receipts or invoices, wire transfer account records,
etc.) and evidence of compliance with the Use of Proceeds section of the Authorization.
The Lender must submit the completed form and all supporting documentation to SBA upon request, or, in the event of a loan
default, with the Lender’s request for guaranty purchase. Providing this information is required to comply with Loan Program
Requirements (as defined in 13 CFR 120.10); failure to provide it when required may impair the Lender’s ability to collect on the
SBA loan guaranty.
If additional space is required to complete the form or provide additional details, please attach a separate sheet.
Instructions for Completing the Form:

1) In the first section, fill in all identifying information. For “Loan Type,” check the box to indicate whether the loan is a
term loan or line of credit. For “Disbursement Type” check the box to indicate whether the disbursement is “initial
disbursement”, “number of disbursements”, or “full disbursement”. Complete the “Use of Proceeds” section with
information related to the initial disbursement.

a) On the line associated with each applicable use of proceeds, indicate:
i) The name of the payee (must identify the ultimate recipient, not an intermediary such as a title company);
ii) Amount disbursed; and
iii) Remaining amount to be disbursed, in accordance with the Authorization.
b) For the “Settlement charges/out of pocket costs” line, insert total amount of settlement charges and other out of

pocket costs in the appropriate field within the grid. Attach an itemized list of all charges and costs, including the
name of payee and amount paid for each charge or cost. (Reminder: SBA Form 159 is required for all fees paid or to
be paid by the Lender (except Lender Service Provider fees) and for all fees paid or to be paid by the Applicant to any
agent in connection with the SBA loan application.)

c) For “Other (Explain),” enter any other use of proceeds authorized in the Authorization that is not already listed in the
grid, if applicable.

2) Complete the “Borrower’s Injection” section.
a) For each type of injection, indicate the source.
b) If the Seller contributed toward required equity, attach a copy of the Note and evidence of full standby for
the life of the loan.

c) Note: The Borrower’s Injection must be in the business bank account prior to any disbursements of
loan proceeds.

3) The Lender and the Borrower must review the certifications and execute the form in the space provided.

SBA Form 1050 (XX-XX) Previous Editions Obsolete

Page 1 of 3

U.S. Small Business Administration

OMB APPROVAL NO.: 3245-0200

Settlement Sheet
SBA Loan Number

Lender Name

Lender FIRS/Location ID Number

SBA Loan Name/Borrower Name

Loan Type:

Term Credit

Disbursement Type

Loan

Note Amount

Line of Credit

Initial Disbursement

# _______ Disbursement

Authorized Use of Proceeds:

Land Acquisition

Construction

with or

New

without improvements

Expansion

Full Disbursement

Name of
Payee:

Renovation

Leasehold Improvements to a property:
owned by Applicant

EXPIRATION DATE: xx/xx/xxxx

Authorized Amount
Remaining:

Amount Disbursed:
$

-

$

-

$

-

$

-

$

$

owned by others

Machinery & Equipment

$

-

$

-

Furniture & Fixtures

$

-

$

-

Inventory Purchase

$

-

$

-

Working Capital

$

-

$

-

Export Working Capital (EWCP or Export Express)

$

-

$

-

Support Standby Letter of Credit (EWCP or Export

$

$

Refinance Existing EWCP or Export LOC (EWCP)

$

$

Business Acquisition (Change of Ownership)

$

$

$

$

Express)

Stock

Asset or

Pay off SBA Loan
SID

Other Lender

Both

Pay Notes Payable
SID

Other Lender

Both

Pay Accounts Payable

$

SBA Guarantee Fee

$

-

$
$

-

Settlement Charges/Out of Pocket Costs

$

-

$

-

Other (Explain):

$

-

$

-

Total: $

-

$

-

Borrower's Injection (including any deposit or earnest money):
Cash

Source:

$

-

Assets

Source:

$

-

$

-

$

-

Total Borrower Injection: $

-

Seller contribution toward required equity (on full standby for life of loan)
Other (Explain):

Page 2 of 3

OMB Control No: 3245-0200
Expiration Date: xx/xx/xxxx

SBA SETTLEMENT SHEET
FORM 1050

At the time of completion of this form, the Lender and the Borrower certify that:
1. The loan proceeds were disbursed and received and will be used in accordance with the Use of Proceeds section of the Authorization, including a ny and
all SBA/Lender approved modifications, and that all required equity or Borrower injections have been made in accordance with the Authorization and any
approved modifications; and
2. There has been no unremedied adverse change in the Borrower’s or Operating Company’s financial condition, organization, management, operations or assets
since the date of application that would warrant withholding or not making this disbursement or any further disbursement.
At the time of each subsequent disbursement on this loan, the Lender, by disbursing the loan proceeds, and the Borrower by receiving them, are deemed to
certify that the above certifications are true with respect to each, and every disbursement made.
WARNING: By signing below you are certifying that the above statements and the information you have provided in all supporting documents is true and accurate to the best of
your knowledge. Submitting false information to the Government may result in criminal prosecution and fines up to $250,000 and/or imprisonment for up to 5 years
under 18 USC § 1001 and/or, under 15 USC § 645, by imprisonment of not more than two years and/or a fine of not more than $5,000. Submitting false statements
to a Federally insured institution may result in fines up to $1,000,000 and/or imprisonment for up to 30 years under 18 USC § 1014, .

Authorized Lender Official

Borrower

Signature:

Signature:

Print Name:

Print Name:

Title:

Title:

Date:

Date:

SBA Form 1050 (XX-XX) Previous Editions Obsolete

Page 3 of 3

NOTE: According to the Paperwork Reduction Act, you are not required to respond to this collection of information unless it displays a currently valid OMB
Control Number. The estimated burden for completing this form, including time for reviewing instructions, and gathering data needed, is 30 minutes. Comments
or questions on the burden estimates or other aspects of this information collection should be sent to U.S. Small Business Administration, Director, RMD, 409 3rd
St., SW, Washington DC 20416 and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Rm. 10202, Washington DC

20503. PLEASE DO NOT SEND THE COMPLETED FORMS TO THESE ADDRESSES.