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STATEMENTS REQUIRED BY LAWS AND EXECUTIVE ORDERS

To comply with legislation passed by the Congress and Executive Orders issued by the President, Federal executive agencies,

including the Small Business Administration (SBA), must notify you of certain information. You can find the regulations and

policies implementing these laws and Executive Orders in Title 13, Code of Federal Regulations (CFR), Chapter 1, or our

Standard Operating Procedures (SOPs). In order to provide the required notices, the following is a brief summary of the various

laws and Executive Orders that affect SBA’s Disaster Loan Programs.

Freedom of Information Act (5 U.S.C. ∋ 552)

This law provides, with some exceptions, that we must make records or portions of records contained in our files available to

persons requesting them. This generally includes aggregate statistical information on our disaster loan programs and other

information such as names of borrowers (and their officers, directors, stockholders or partners), loan amounts at maturity, the

collateral pledged, and the general purpose of loans. We do not routinely make available to third parties your proprietary data

without first doing pre-notification, required by Executive Order 12600, or information that would cause competitive harm or

constitute a clearly unwarranted invasion of personal privacy.

Send a request under this Act to the SBA office maintaining the records requested and identify it as a Freedom of Information

Act (FOIA) request. The request must describe the specific records you want. For information about the FOIA, contact the

Chief, FOI/PA Office, 409 3

Street, SW, Suite 5900, Washington, DC 20416, or by e-mail at foia@sba.gov.

Privacy Act (5 U.S.C. ∋ 552a)

You can request to see or get copies of any personal information that we have in your file, when that file is retrieved by

individual identifiers, such as name or social security number. Requests for information about another party may be denied

unless we have the written permission of the individual to release the information to the requestor or unless the information is

subject to disclosure under the Freedom of Information Act. The Agreements and Certifications section of this form contains

written permission for us to disclose the information resulting from this collection with state, local or private disaster relief

services.

Under the provisions of the Privacy Act, you are not required to provide social security numbers; nor can you be denied a loan or

other form of assistance solely because you did not provide a social security number. Disclosures of name and other personal

identifiers are also voluntary. However, we require an individual seeking assistance to provide sufficient information for us to

make a character determination. As a result, if you do not provide your social security number and other personal identifiers, we

may not have sufficient information upon which to reach a favorable determination. Having this information makes it easier for

us to more accurately identify to whom adverse credit or other information applies and to keep accurate loan records.

Note: Any person concerned with the collection, use and disclosure of information, under the Privacy Act may contact the Chief,

FOI/PA Office, 409 3

Street, SW, Suite 5900, Washington, DC 20416 or by e-mail at foia@sba.gov for information about the

Agency’s procedures relating to the Privacy Act and the Freedom of Information Act.

Right to Financial Privacy Act of 1978 (12 U.S.C. ∋ 3401 et seq.)

This notifies you, as required by the Right to Financial Privacy Act of 1978 (Act), of our right to access financial records held by

financial institutions that were or are doing business with you or your business. This includes financial institutions participating

in loans or loan guarantees.

The law provides that we may access your financial records when considering or administering Government loan or loan

guaranty assistance to you. We must give a financial institution a certificate of our compliance with the Act when we first

request access to your financial records. No other certification is required for later access. Our access rights continue for the

term of any approved loan or loan guaranty. We do not have to give you any additional notice of our access rights during the

term of the loan or loan guaranty.

We may transfer to another Government authority any financial records included in a loan application or about an approved loan

or loan guaranty as necessary to process, service, liquidate, or foreclose a loan or loan guaranty. We will not permit any transfer

of your financial records to another Government authority except as required or permitted by law.

Debt Collection Act of 1982 and Deficit Reduction Act of 1984 (31 U.S.C. ∋ 3701 et seq. and other titles)

These laws require us to aggressively collect any delinquent loan payments. You must give your taxpayer identification number

to us when you apply for a loan. If you receive a loan and do not make payments when they become due, we may take one or

more of the following actions (this list may not be exhaustive):

*Report the delinquency to credit reporting bureaus.

*Offset your income tax refunds or other amounts due to you from the Federal Government.

*Refer the account to a private collection agency or other agency operating a debt collection center.

*Suspend or debar you from doing business with the Federal Government.

*Refer your loan to the Department of Justice.

*Foreclose on collateral or take other actions permitted in the loan instruments.

*Garnish wages.

*Sell the debt.

*Litigate or foreclose.

Paperwork Reduction Act (44 U.S.C. Chapter 35)

We are collecting the information on this form in order to make disaster loans available to qualified small businesses. The form

is designed to collect the information necessary for us to make eligibility and credit decisions in order to fund or deny loan

requests. We will also use the information collected on this form to produce summary reports for program and management

analysis, as required by law.

PLEASE NOTE: The estimated burden for completing this form is 3 hours. Your responses to the requested information are

required in order to obtain a benefit under SBA’s Disaster Business Loan Program. However, you are not required to respond to

any collection of information unless it displays a currently valid OMB approval number. If you have any questions or comments

concerning any aspects of this information collection, please contact the U.S. Small Business Administration Information Branch,

409 3

St., SW, Washington, DC 20416 and Desk Officer for SBA, Office of Management and Budget, Office of Information

and Regulatory Affairs, 725 17

St., NW, Washington, DC 20503. (3245-0017) PLEASE DO NOT SEND FORMS TO OMB.

Policy Concerning Representatives and Their Fees

When you apply for an SBA loan, you may use an attorney, accountant, engineer, appraiser or other representative to help

prepare and present the application to us. You are not required to have representation. If an application is approved, you may

need an attorney to help prepare closing documents.

There are no “authorized representatives” of SBA, other than our regular salaried employees. Payment of a fee or gratuity to our

employees is illegal and will subject those involved to prosecution.

SBA Regulations prohibit representatives from proposing or charging any fee for services performed in connection with your

loan unless we consider the services necessary and the amount reasonable. The Regulations also prohibit charging you any

commitment, bonus, broker, commission, referral or similar fee. We will not approve the payment of any bonus, brokerage fee or

commission. Also, we will not approve placement or finder’s fees for using or trying to use influence in the SBA loan

application process.

Fees to representatives must be reasonable for services provided in connection with the application or the closing and based upon

the time and effort required, the qualifications of the representative, and the nature and extent of work performed.

Representatives must execute a compensation agreement.

In the appropriate section of the application, you must state the names of everyone employed by you or on your behalf. You

must also notify the SBA disaster office in writing of the names and fees of any representative you employ after you file your

application.

If you have any questions concerning payment of fees or reasonableness of fees, contact the Field Office where you filed or will

file your application.

Occupational Safety and Health Act (29 U.S.C. ∋ 651 et seq.)

This legislation authorizes the Occupational Safety and Health Administration (OSHA) in the Department of Labor to require

businesses to modify facilities and procedures to protect employees when appropriate. If your business does not do so, you may

be penalized, forced to close or prevented from starting operations in a new facility. Because of this, we may require information

from you to determine whether your business complies with OSHA regulations and may continue operating after the loan is

approved or disbursed. You must certify to us that OSHA requirements applying to your business have been determined and that

you are, to the best of your knowledge, in compliance.

U.S. Small Business Administration

DISASTER BUSINESS LOAN APPLICATION

OMB No. 3245-0017

Physical Damage Filing Deadline Declaration Number(s)

Are you applying for:

Economic Injury Filing Deadline

Physical Damage Economic Injury

FEMA Registration Number, If Known

FILING REQUIREMENTS (please submit)

1. Copies of the applicant’s 3 most recent Federal Income Tax Returns, including all schedules. If this is a new business that has not filed 3 Federal

Tax Returns, submit the ones you have filed. Also, complete and sign the attached Tax Information Authorization (IRS Form 8821). Sole

proprietors need only submit the IRS Form 8821. We will contact you if we need any additional information (i.e., forecasts, etc.).

2. A current (dated within 90 days of application) business balance sheet (you may use the attached Personal Financial Statement (SBA Form 413)

if you are a sole proprietorship), a current profit and loss statement, and a current schedule of liabilities. (We attached a sample schedule of

liabilities for your convenience.)

3. For each owner having a 20% or more interest and each general partner, a current (dated within 90 days of application) personal financial

statement (you may use SBA Form 413 for this purpose), a complete copy, including all schedules, of the most recent Federal Income Tax Return

and a complete and signed IRS Form 8821. Individuals with an ownership interest need only supply an IRS Form 8821 and a personal financial

statement.

4. A complete copy, including all schedules, of the latest Federal Income Tax Return for each affiliate. Affiliates include, but are not limited to,

business parents, subsidiaries or other businesses with common ownership or management. Also, you must have an authorized individual

complete and sign the attached IRS Form 8821 for each affiliate.

5. If you are applying for physical damage, complete and sign the attached Verification of Business Property (SBA Form 739A).

6. If your insurance covers all or a part of this loss (regardless of the current status of your claim), please provide the name and telephone number

of your agent and/or claims adjuster. Also, include the policy number and the name of the insurance company.

7. If you are applying for economic injury, please submit the attached SBA Form 1368, Additional Filing Requirements – Economic Injury Disaster

Loan (EIDL).

IF SBA APPROVES YOUR LOAN, WE MAY REQUIRE ADDITIONAL INFORMATION BEFORE LOAN CLOSING. WE

WILL ADVISE YOU, IN WRITING, OF WHAT DOCUMENTS WE WILL NEED.

8. APPLICANT’S LEGAL NAME 9. TELEPHONE NUMBER (including area code)

10. TRADE NAME (if different from legal name) 11. FEDERAL E.I.N. (if applicable)

12. MAILING ADDRESS

County State ZipNumber, street, and/or P.O. Box No. City

13. DAMAGED PROPERTY ADDRESS(ES) (If you need more space, attach additional sheets.)

State ZipNumber, street, or rural route City County

14. BUSINESS PROPERTY IS: Owned Leased 15. TYPE OF BUSINESS

16. AMOUNT OF LOAN REQUEST

17. UNDER CURRENT MGMT. SINCE:

(If unknown enter a question mark)

18. DATE BUSINESS ESTABLISHED 19. NUMBER OF EMPLOYEES

20. MANAGEMENT (If you need more space, attach additional sheets.) Complete for each: 1) proprietor; or 2) limited partner who owns 20% or

more interest and general partner; or 3) stockholder owning 20% or

more voting stock.

Name

Title/Office % Owned

Social Security Number* (Area Code) Telephone Number Date of Birth* Place of Birth*

Name Title/Office % Owned

Social Security Number* (Area Code) Telephone Number Date of Birth* Place of Birth*

*For information about these questions, see the attached Statements Required by Laws and Executive Orders.

SBA Form 5 (1-01) Ref SOP 50 30

21. For each individual listed in Item 20, please respond to the following questions, providing dates and details.

(If you need more space, attach additional sheets.)

a. or insolvency proceedings, except as stated:________________________________. Has never been involved in bankruptcy

b. tax liens, or pending lawsuits against them, except as stated:_________________________. Has no outstanding judgments,

c. Has not been convicted of a criminal offense committed during and in connection with a riot or civil disorder, nor is such person or

the applicant engaged in the production or distribution of any product or service that has been determined to be obscene by a

court of competent jurisdiction, except as stated:_____________________________________________________________.

d. Federal loans or Federally guaranteed loans, except as stated:__________________________________. Has never had any

e. Is not delinquent on any Federal taxes, direct or guaranteed loans (SBA, FHA, VA, student, etc.), contracts, grants, or any child

support payments, except as stated:_______________________________________________________________________.

22. ner, owner’s spouse or household member works for SBA, except:__________________________________________ No ow

23. Are any of the individuals listed in Item 20: (a) presently under indictment, on parole or probation, or have they been; (b) charged

with or arrested for any criminal offense (including offenses which have been dismissed, discharged, or not prosecuted) other than

a minor motor vehicle violation; or (c) convicted, placed on pretrial diversion, or placed on any form of probation including

adjudication withheld pending probation for any criminal offense other than a minor motor vehicle violation?

YES

24. If you are a sole proprietor, are you a U.S. citizen? YES NO

25. ORGANIZATION TYPE Sole Proprietorship Partnership Limited Partnership

Corporation Nonprofit Organization Other:_____________________

26. If anyone completes this application for you, whether you pay a fee for this service or not, that person must sign in the space below:

Name and address of representative (please print and sign) Fee charged or agreed upon

If my application is approved, I may be eligible for additional funds to cover the cost of mitigating measures. It is not necessary for the

description and cost estimates to be submitted with the application. SBA approval of the mitigating measures will be required before

any loan increase. By checking this box, I am interested in having SBA consider this increase.

AGREEMENTS AND CERTIFICATIONS

On behalf of the undersigned individually and for the applicant business:

I authorize my insurance company, bank, financial institution, or other creditors to release to SBA all records and information

necessary to process this application.

You have my permission to release information in connection with this application to Federal, State, local, or private organizations

that provide relief for disaster related purposes.

I will not exclude from participating in, or deny the benefits of, or otherwise subject to discrimination under any program or activity for

which I receive Federal financial assistance from SBA, any person on grounds of age, color, handicap, marital status, national

origin, race, religion or sex.

I will report to the SBA Office of the Inspector General, Washington, DC 20416, any Federal employee who offers, in return for

compensation of any kind, to help get this loan approved. I have not paid anyone connected with the Federal government for help in

getting this loan.

All information in this application is true and complete to the best of my knowledge. All financial statements submitted with the

application fully and accurately present the financial position of the business. I have not omitted any disclosures in these financial

statements. This certification also applies to any financial statements submitted after this date. I understand that false statements

may result in the forfeiture of benefits and possible prosecution by the U.S. Attorney General (reference 18 U.S.C. 1001 and/or 15

U.S.C. 645).

SIGNATURE TITLE DATE

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