SBA Form 2181 SBIC Significant Investor Declarations

Declarations of Significant Investors

As of Date:

MM/DD/YYYY

This declaration must be signed by each investor that owns 50% or more of the ownership interests of the applicant if that investor is not required to sign the "Form 2181 Exhibit B: Declarations of Principals and Control Persons."

Name of Applicant:

ABC SBIC, L.P.

1

The undersigned certifies that all information submitted by it or on its behalf in connection with SBA Form 2181, related attachments and exhibits is true and correct to the best of its knowledge. The undersigned also certifies that it is submitting this information for the purpose of obtaining an ownership interest in, or a license to operate as, a Small Business Investment Company (SBIC). The undersigned understands that all statements made by it or on its behalf in connection with SBA Form 2181, related attachments and exhibits are considered material by SBA in evaluating the Applicant’s application for a license to operate as an SBIC.

2

The undersigned understands that knowingly making a false statement in connection with this application is a violation of Federal law and is subject to criminal prosecution under 18 USC §§ 287, 371, 1001, 1006, and 1014, including fines up to $1 million and up to 30 years imprisonment, 15 USC §§ 645 and 687(f), civil penalties under 31 USC § 3729; government-wide debarment or suspension; and denial, suspension, or revocation of an SBIC license.

3

The undersigned has not obtained, directly or indirectly, any of the funds it is investing in the SBIC from any SBIC or any business financed by an SBIC, and will not use any proceeds of a financing by any SBIC to repay any obligation that it has incurred, directly or indirectly, in connection with the purchase of its ownership in the SBIC.

4

The undersigned will not participate in or consent to any action by the SBIC that to the best of its knowledge and belief constitutes a violation of the Small Business Investment Act of 1958, as amended, or that constitutes a violation of SBA regulations.

5

Printed Investor Name

6

Title

7

Signature

8

Date