SBA Form 2181 SBIC Individual Declarations

Declarations of Principals and Control Persons

As of Date:

MM/DD/YYYY

This declaration is to be completed by each of the principals (as defined in the application instructions) and Control Persons (as defined in 13 CFR §107.50) of the applicant, signed with the submission of an SBIC MAQ, and resubmitted in the event of material changes at the time of final License Application. If any new principals or Control Persons ) are added to the applicant after submitting the MAQ, a declaration signed by such new principal or Control Person must be submitted to SBA as soon as possible in order to reduce licensing delays. If a new principal or new Control Person is to be added to the SBIC after it is licensed, a declaration signed by the new principal or Control Person must be submitted to SBA as soon as possible.

Name of Applicant:

ABC SBIC, L.P.

1

The individuals and/or entities identified in this declaration in Item 9 below constitute all of the principals and Control Persons of the applicant and I certify that all information submitted in connection with the SBA Form 2181, related attachments, and exhibits is true and correct to the best of my knowledge. I also certify that this information is being submitted for the purpose of obtaining a license to operate as, or approval of a change in the ownership or management of, a Small Business Investment Company (SBIC). I agree that all statements made in connection with the SBA Form 2181, related attachments and exhibits are considered material for the purpose of inducing the SBA to issue a license, approve the management and ownership of the applicant, and to disburse SBA funds in reliance on such statements.

2

If this Application is approved, I will operate the SBIC in full conformity with the Small Business Investment Act of 1958, as amended, and SBA regulations. I understand that if a license is granted on the basis of this Application, this Application will become an agreement with SBA within the meaning of 13 CFR 107.507. Accordingly, nonperformance is a violation of 13 CFR 107.507.

3

I understand that knowingly making a false statement in connection with this Application is a violation of Federal law and is subject to criminal prosecution and civil penalties under 18 USC 287, 371, 1001, 1006 and 1014, including fines of up to $1 million and up to 30 years imprisonment; 15 USC 645 and 687(f);civil penalties under 31 USC 3729; government-wide disbarment or suspension; and denial, suspension, or revocation of a small business investment company license.

4

I have not used and will not use, directly or indirectly, any funds advanced by any SBIC to any small business concern, or any funds available as a result of funds advanced by an SBIC to a small business concern, to purchase any securities of the SBIC or to repay any obligation incurred in connection with the purchase of any securities of the SBIC.

5

Printed Name

6

Title

7

Signature

8

Date

9

List of Principals and Control Persons

First Name/ Entity Name

Last Name

Title

Entity