Individual Declarations

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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
§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 s
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 t
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/
Title
Entity Name Last Name

Entity

d Control Persons (as defined in 13 CFR
aterial changes at the time of final
the MAQ, a declaration signed by such
delays. If a new principal or new
ontrol Person must be submitted to

ls and Control Persons of
attachments, and
mitted for the purpose of
Business Investment
ments and exhibits are
nd ownership of the

ent Act of 1958, as
this Application will
a violation of 13 CFR

of Federal law and is
g fines of up to $1 million
-wide disbarment or

iness concern, or any
ecurities of the SBIC or to