Form SBA Form 1050 SBA Form 1050 Settlement Sheet

SBA FORM 1050, SETTLEMENT SHEET

OMB Approval No.: 3245-0200
Expiration Date: XX/XX/XXXX

Purpose: The purpose of this form is to document and verify that loan proceeds have been disbursed
in accordance with the Authorization and to document that the Borrower’s contribution has been
injected into the business prior to the Lender disbursing any loan proceeds.
General Instructions: This form must be used for standard 7(a) loans over $350,000 and for Preferred
Lender Program (PLP) loans. This form may be used for all 7(a) loans.
This form is to be completed by the Lender and signed by the Lender and the Borrower at the time of
the initial loan disbursement. The Lender must retain a copy of the signed form in its loan file. For all
disbursements, the Lender must also retain documentation that is acceptable to SBA (such as joint
payee checks, cancelled checks, paid receipts or invoices, wire transfer account records, etc.) and
that evidences compliance with the Use of Proceeds section of the Authorization.
The Lender must submit the completed form and all supporting documentation to SBA upon
request, or, in the event of a loan default, with the Lender’s request for guaranty purchase.
Providing this information is required to comply with program requirements; failure to provide it
when required may impair the Lender’s ability to collect on the SBA loan guaranty.
Specific Instructions for Completing the Form:
1) In the first section, fill in all identifying information. For “Loan Type,” check the box to indicate
whether the loan is a term loan or a revolving line of credit.
2) Complete the ”Use of Proceeds” section with information related to the initial disbursement.
a) On the line associated with each applicable use of proceeds, indicate:
i)

The name of the payee (must identify the ultimate recipient, not an intermediary such
as a title company);

ii) Amount disbursed; and
iii) Remaining amount to be disbursed, in accordance with the Authorization.
b) For the “Settlement charges/out of pocket costs” line, insert total amount of settlement
charges and other out of pocket costs in the appropriate field within the grid. Attach an
itemized list of all charges and costs, including the name of payee and amount paid for each
charge or cost. (Reminder: SBA Form 159 is required for all fees charged to the Lender
(except Lender Service Provider fees) or Applicant in connection with the SBA loan
application.)
c) For “Other (Explain),” enter any other use of proceeds authorized in the Authorization that is
not already listed in the grid, if applicable.
3) Complete the “Borrower’s Injection” section.
a) For each type of injection, indicate the source.
b) If the Seller contributed toward required equity, attach a copy of the Note and
evidence of full standby for the life of the loan.
c) Note: The Borrower’s Injection must be in the business bank account prior to any
disbursement of loan proceeds.
4) The Lender and the Borrower must review the certification and execute the form in the space provided.
SBA Form 1050 (XX-XX) Previous Editions Obsolete

Page 1 of 2

U.S. Small Business Administration

OMB APPROVAL NO.: 3245-0200

Settlement Sheet
SBA Loan Number

Lender Name

Lender FIRS Number

SBA Loan Name

Note Amount

Loan Type:

Term Loan

Revolving Line of Credit

Authorized Use of Proceeds:
Land Acquisition:
Construction:

Raw
New

EXPIRATION DATE: XX/XX/20XX

Name of Payee:

Improved

Expansion

Renovations

Authorized Amount
Remaining:

Amount Disbursed:
$

-

$

-

$

-

$

-

Leasehold Improvements to property owned by others

$

-

$

-

Machinery & Equipment

$

-

$

-

Furniture & Fixtures

$

-

$

-

Inventory Purchase

$

-

$

-

Working Capital

$

-

$

-

Acquire Business (Change of Ownership)

$

-

$

-

SBA Guarantee Fee

$

-

$

-

Settlement Charges/Out of Pocket Costs

$

-

$

-

Other (Explain):

$

-

$

-

Total: $

-

$

-

Borrower's Injection (including any deposit or earnest money):
Cash

Source:

$

-

Assets

Source:

$

-

Seller contribution toward required equity (on full standby for life of loan)

$

-

Other (Explain):

$

-

Total Borrower Injection: $

-

At the time of initial disbursement of this loan, the Lender and the Borrower certify that:
1. The loan proceeds were disbursed and received and will be used in accordance with the Use of Proceeds section of the Authorization, including any and
all SBA/Lender approved modifications, and that all required equity or Borrower injections have been made in accordance with the Authorization and any
approved modifications; and
2. There has been no unremedied adverse change in the Borrower’s or Operating Company’s financial condition, organization, management, operations or assets
since the date of application that would warrant withholding or not making this disbursement or any further disbursement.
At the time of each subsequent disbursement on this loan, the Lender, by disbursing the loan proceeds, and the Borrower by receiving them, are deemed to
certify that the above certifications are true with respect to each and every disbursement made.
WARNING: By signing below you are certifying that the above statements are accurate to the best of your knowledge. Submitting false information to the Government
may result in criminal prosecution and fines up to $250,000 and/or imprisonment for up to 5 years under 18 USC § 1001. Submitting false statements to a Federally
insured institution may result in fines up to $1,000,000 and/or imprisonment for up to 30 years under 18 USC § 1014, penalties under 15 USC § 645, and/or civil fraud
liability.
Authorized Lender Official

Borrower

Signature:

Signature:

Print Name:

Print Name:

Title:

Title:

Date:

Date:

SBA Form 1050 (XX-XX) Previous Editions Obsolete

Page 2 of 2

NOTE: According to the Paperwork Reduction Act, you are not required to respond to this collection of information unless it
displays a currently valid OMB Control Number. The estimated burden for completing this form, including time for reviewing
instructions, and gathering data needed, is 30 minutes. Comments or questions on the burden estimates or other aspects of this
information collection should be sent to U.S. Small Business Administration, Director, RMD, 409 3rd St., SW, Washington DC
20416 and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Rm. 10202, Washington
DC 20503. PLEASE DO NOT SEND THE COMPLETED FORMS TO THESE ADDRESSES.