SBA 34 Bank Identification Form

OMB Approval No.: 3245-0081
Expiration Date: 11-30-2011

Office of Investment
Investment Division
Small Business Administration
Instructions for Bank Identification Form (SBA Form 34)
(Funding Net Proceeds)
The Small Business Administration has made arrangements to have the proceeds of the
funding of SBA-Guaranteed SBIC Leverage disbursed to SBICs by wire transfer of funds to
the bank accounts of the SBICs. This procedure will minimize the time lag between receipt
of the proceeds of the funding and the availability of the net proceeds to the SBICs.
An SBIC's account may or may not be with a MEMBER BANK OF THE FEDERAL
RESERVE SYSTEM ("MEMBER BANK"). If an SBIC's account is with a MEMBER
BANK, the SBA or its agent will wire the net proceeds of the funding directly to the SBIC's
bank for credit to the SBIC's bank account.
If the SBIC's account is not with a MEMBER BANK, the non-member bank or other
financial institution where the funds are to be deposited must have a correspondent or
affiliated bank that is a MEMBER BANK. In this case, the SBA or its agent will wire the
net proceeds of the funding to the correspondent or affiliated MEMBER BANK which will
then credit the SBIC's bank or financial institution for further credit to the SBIC's account.
To receive funds, each SBIC must furnish the requested information, and have an authorized
official sign and date the attached form. Please submit an updated SBA Form 34 to us
whenever the banking information provided changes, and you plan to draw upon an
outstanding SBA commitment for Leverage. Submit any new form by both fax [Fax # (202)
205-6075)], and mail [U.S. Small Business Administration, Investment Division, Funding
Admin. Branch, 409 Third Street, SW, Washington, DC 20416].
Please answer the questions on the attached form and provide the information required.
CAUTION: Failure to provide any part of this information, or the filing of inaccurate
information may delay your receipt of funds or prevent SBA or its agents from including
your leverage request in the funding.
PLEASE NOTE: The estimated burden for completing this form is 20 minutes per response. You are not required to
respond to any collection of information unless it displays a currently valid OMB approval number. Comments on the
burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St., S.W., Washington D.C. 20416 and
Desk Officer for the Small Business Administration, Office of Management and Budget, New Executive Office Building,
Room 10202, Washington, D.C. 20503. OMB Approval (3245-0081). Do not Send Forms to OMB.

SBA Form 34 (Revised 12-08) (Instructions)

BANK IDENTIFICATION FORM

FOR

DISBURSEMENT OF LICENSEE'S AMOUNT OF NET PROCEEDS
ANSWER THE FOLLOWING QUESTION AND READ THE INSTRUCTIONS BEFORE
COMPLETING THE INFORMATION REQUIRED BELOW.
Is your account with a bank that is a MEMBER OF THE FEDERAL RESERVE SYSTEM

(MEMBER BANK)?

(Check one)
[ ] YES
[ ] NO

If the answer to the above question is YES, complete only Section I below.

If the answer to the above question is NO, complete both Sections I & II below.

SBIC BANK IDENTIFICATION INFORMATION
Section I -- MEMBER BANK (INCLUDING CORRESPONDENT OR AFFILIATED
MEMBER BANK):
Bank Account Number:
ABA Number:
Name of Bank:
Street Address:
City:

State

Zip

Section II -- NON-MEMBER BANK OR OTHER FINANCIAL INSTITUTION:

Bank Account Number:

Name of Bank or Other:

Financial Institution

Additional Information (if needed):

Street Address:

City

State

Zip

By:
(Name of SBIC)

(Authorized Signature)
SBA Form 34 (Revised 12-08)

(Date)