# SBA Form 912: Statement of Personal History

**Short answer:** SBA Form 912 is the Statement of Personal History. Anyone your lender or SBA asks completes it, when requested. Form 1919 already asks the criminal history question on 7(a) loans, and Form 1244 on 504 loans. SOP 50 10 8.1 does not mention Form 912.

Canonical page: https://www.sbaexpress.loans/forms/sba-form-912/
Last checked: 2026-11-09

Edition in use

SBA Form 912, marked (12/2028), OMB 3245-0178. SBA updated its page February 23, 2026. The PDF prints an expiration of December 31, 2028. OMB's approval record and SBA's file name say January 31, 2029.

[See the form on sba.gov](https://legacy.sba.gov/document/sba-form-912-statement-personal-history)

## Who completes it

Anyone your lender or SBA asks. SOP 50 10 8.1 does not mention Form 912, and the form points back to SBA rules.

## When it is used

When requested. Form 1919 already asks the criminal history question on 7(a) loans, and Form 1244 on 504 loans.

## What it asks

- The business name and address, and your full name with all former names and the dates you used them.
- Your ownership percentage, Social Security number, date and place of birth, and citizenship.
- Your current address and most recent prior address, unless that is over 10 years old.
- Whether you are incarcerated, serving a sentence, or under indictment for a felony or a crime of financial misconduct or false statement. A business with such an Associate is ineligible (13 CFR 120.110(n)).
- Whether, in the past year, you were convicted of an offense tied to a riot, civil disorder or other declared disaster.
- Whether you are more than 60 days late on child support.
- Your authorization for SBA to request your criminal record information.

## A filled-in example

This example is made up. Sample Bakery LLC, the people, the lender and every figure are fictional, and the ID numbers are zeros. It shows what finished entries look like, using the form's own field names.

**Made-up entries for SBA Form 912**

| Field on the form | Example entry |
| --- | --- |
| 1a. Name and address of Applicant/Borrower/Assumptor | Sample Bakery LLC, 100 Example Street, Anytown, OH 00000 |
| 1b. Personal Statement of (name in full, former names and dates used) | Pat NMN Sample. No former names. |
| 2. Percentage of ownership in the small business | 100% |
| 3. Social Security Number | 000-00-0000 |
| 4. Date of Birth | 01/01/1980 |
| 5. Place of Birth | Anytown, Ohio |
| 6. Are you a United States Citizen? | Yes, I am a United States Citizen. Initials: PS |
| 7. Present Residence Address | From 06/2015 to present. 200 Sample Lane, Anytown, OH 00000 |
| 8. Currently incarcerated, serving a sentence or under indictment for the listed crimes? | No. Initials: PS |
| 9. Convicted in the past year of an offense tied to a riot, civil disorder or declared disaster? | No. Initials: PS |
| 10. More than 60 days late on any child support obligations? | No. Initials: PS |
| Signature, Title, Date | (signed) Pat Sample, Managing Member, 10/01/2026 |

An example only. Use your own facts on the real form, and check that your copy is the edition named above.

## Common mistakes

- Assuming every SBA loan needs one. SOP 50 10 8.1 does not mention Form 912, and its Appendix 1 does not list it. Whether a lender asks for one varies by lender.
- Confusing it with Form 1081. That statement of personal history is for non-bank lenders, certified development companies and microlenders (SOP 50 10 8.1, Appendix 1).
- Skipping the initials. Questions 6, 8, 9 and 10 each have an initials line.
- Leaving out former names. The form asks for every former name and the dates you used it. Write NMN if you have no middle name.
- Mailing it to OMB. The form says that delays processing. Use the address your SBA representative provides.
- Giving a false answer. A knowing false statement is a federal crime. It carries up to five years in prison, a fine up to $250,000, or both (18 U.S.C. 1001 and 3571).

## Sources

- [SBA Form 912 (12/2028), Statement of Personal History](https://legacy.sba.gov/sites/default/files/2026-02/Form%20912%20expires%201.31.2029.pdf)
- [SOP 50 10 8.1, Appendix 1 (p. 289)](https://legacy.sba.gov/sites/default/files/2026-10/SOP%2050%2010%208.1%20Technical%20Policy%20Updates%20effective%20%2010.1.2026.docx)
- [SOP 50 10 8.1, Sec. C, Ch. 1, Para. F.2.a.i (about p. 258)](https://legacy.sba.gov/sites/default/files/2026-10/SOP%2050%2010%208.1%20Technical%20Policy%20Updates%20effective%20%2010.1.2026.docx)
- [SBA Form 1919 (02/2025), question 4](https://legacy.sba.gov/sites/default/files/2025-03/2025.02.27%20Form%201919%20-%20Updates%20%28FINAL%29_03-12-2025%20%281%29.pdf)
- [13 CFR § 120.110](https://www.ecfr.gov/current/title-13/section-120.110)
- [OMB information collection 3245-0178, ICR 202512-3245-003](https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=202512-3245-003)