No Loss of Gvt Debt Form
Losses on any Current and Previous SBA Loan And Other Federal Government Financing
The Applicant or any associates, affiliates, or principals connected with this loan state that there has not been
a loss to the government as a result of a charge off, compromise or discharge due to bankruptcy of any of the
debt. A LOSS is the outstanding principal balance of the loan that the government agency had to write off
after all collection activities including compromises were finalized.
1) Federal debt include SBA loan, USDA, or any type of government financing;
2) Federal debt include Student Loans, FmHA or FEMMA loans;
3) Federal debt borrowed by any other business currently or previously owned by any principal of the
applicant.
Signed by:
Previous Government financing:
Type of Federal assistance (SBA/B&I/FHA etc.)*
1. __________. Loan #_________ Date acquired:________ Date paid off:________
2. __________. Loan #_________ Date acquired:________ Date paid off:________
3. __________. Loan #_________ Date acquired:________ Date paid off:________
4. __________. Loan #_________ Date acquired:________ Date paid off:________
5. __________. Loan #_________ Date acquired:________ Date paid off:________
6. __________. Loan #_________ Date acquired:________ Date paid off:________
Active and outstanding government enhanced credit facilities should be reflected in the schedule of debt format
provided by CDCSW or the lender.
Copies of government enhanced credit facilities should be provided with the application. Copy of the Note or
Authorization must be included.
