This section captures fundamental borrower identification and facility-level reference data essential for credit file documentation and committee review.
Borrower Legal Entity Name
Borrower Master Account Number/Customer ID
Primary Industry Sector Classification
Manufacturing
Real Estate & Construction
Wholesale & Retail Trade
Transportation & Logistics
Information Technology
Energy & Utilities
Healthcare & Pharmaceuticals
Financial Services
Agriculture & Mining
Professional Services
Hospitality & Tourism
Other
Specific Industry Sub-Segment
Facility Agreement Reference Number
Facility Type
Term Loan (Senior Secured)
Term Loan (Senior Unsecured)
Revolving Credit Facility
Asset-Based Lending Facility
Project Finance Facility
Acquisition Finance Facility
Bridge Loan
Syndicated Facility
Bilateral Facility
Other
Original Facility Commitment Amount
Current Outstanding Principal Balance
Facility Currency
Facility Agreement Effective Date
Current Facility Maturity Date
Primary Relationship Manager Name
Credit Officer/Underwriter Name
Tenure of Banking Relationship (Years)
Total Aggregate Exposure Across All Facilities
Current Internal Risk Grade
Investment Grade (AAA to BBB-)
Sub-Investment Grade (BB+ to BB-)
Highly Speculative (B+ to B-)
Substantial Risk (CCC+ to CCC-)
Extremely Speculative (CC to C)
Default (D)
Not Rated
Is the borrower part of a larger consolidated group structure?
Ultimate Parent Entity Name and Relationship
This section documents the specific covenant violation, quantifies the financial metric deviation, and assesses the severity and root cause of the breach.
Type of Covenant Breached
Financial Covenant - Leverage Ratio
Financial Covenant - Interest Coverage Ratio
Financial Covenant - Debt Service Coverage Ratio
Financial Covenant - Minimum Net Worth
Financial Covenant - Current Ratio
Financial Covenant - Fixed Charge Coverage
Non-Financial Covenant - Information Covenants
Non-Financial Covenant - Negative Pledge
Non-Financial Covenant - Restricted Payments
Non-Financial Covenant - Asset Disposition
Other
Specific Covenant Clause Reference (Agreement Section & Wording)
Covenant Threshold/Required Value
Actual Reported Value at Breach
Variance (Absolute Deviation from Threshold)
Variance Percentage ((Actual - Threshold)/Threshold * 100)
Covenant Testing Period End Date
Date Breach Was Identified and Reported
Is this the first instance of this specific covenant breach?
Provide historical breach chronology including dates, severity, and prior waivers granted
Trend Direction of Breached Metric
Improving (moving toward compliance)
Deteriorating (moving away from compliance)
Stable but non-compliant
Volatile with unpredictable trajectory
Root Cause Analysis of Covenant Breach
Contributing Factors to Covenant Breach (Select all applicable)
COVID-19 or pandemic-related disruptions
Supply chain constraints or input cost inflation
Customer concentration risk materialization
Interest rate environment changes
Foreign exchange volatility
One-time extraordinary charges (restructuring, litigation)
Working capital cycle elongation
Capital expenditure overruns
Acquisition integration challenges
Management execution issues
Industry cyclical downturn
Regulatory or policy changes
Force majeure events
Other
Financial Metric Delta Analysis - Comparative Trend (Last 4 Quarters)
Metric Name | Q-3 Value | Q-2 Value | Q-1 Value | Current Quarter (Breach) | Covenant Threshold | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | Consolidated Leverage Ratio | 2.8 | 2.9 | 3.1 | 3.4 | 3 | |
2 | Interest Coverage Ratio | 4.2 | 4 | 3.8 | 3.5 | 3.5 | |
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This section evaluates the borrower's articulated strategy for restoring liquidity, returning to covenant compliance, and ensuring long-term viability.
Primary Nature of Liquidity Bottleneck
Temporary cash flow timing mismatch
Working capital absorption from growth
Revenue decline and margin compression
Debt service burden from maturities
Covenant breach triggering acceleration risk
Loss of key customer or contract
Asset impairment or write-downs
Refinancing market access constraints
Other
Detailed Description of Liquidity Constraint Mechanics
Expected Date of Liquidity Crisis Resolution
Estimated Liquidity Shortfall Amount
Recovery Plan Type
Operational turnaround (cost reduction, efficiency gains)
Asset divestiture or sale-leaseback
Equity infusion or shareholder loan
Working capital optimization
Debt refinancing or reprofiling
Covenant reset and waiver request only
Strategic M&A or partnership
Receivables factoring or securitization
Other
Specific Recovery Initiatives and Actions
Recovery Plan Milestone Tracking
Initiative/Action Item | Target Completion Date | Responsible Party | Expected Cash Impact | Completed? | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Headcount reduction - 15% SG&A | 4/30/2025 | CFO/HR | $2,500,000.00 | ||
2 | Sale of non-core manufacturing facility | 6/15/2025 | CEO/Advisor | $12,000,000.00 | ||
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Has management provided revised financial projections demonstrating return to covenant compliance?
Projected Date of Covenant Compliance Restoration
Explain the absence of forward-looking projections and how compliance will be demonstrated
Are third-party financial or operational advisors engaged?
Provide advisor names, mandates, fees, and assessment of their credibility
Management's Narrative on Business Viability and Going Concern Assessment
Upload Borrower's Formal Recovery Plan Document (Board-approved if available)
Upload Revised Financial Model with Sensitivity Cases (Base, Downside, Upside)
Does the recovery plan assume any additional bank accommodation beyond this waiver request?
Detail additional accommodations required (e.g., further covenant resets, payment holidays, additional liquidity)
This section aggregates the bank's total credit exposure to the borrower and group, reassesses collateral valuation adequacy, and evaluates the impact on risk grading and provisioning.
Total On-Balance Sheet Exposure to Borrower (All Facilities)
Total Off-Balance Sheet Exposure (Guarantees, LC, Undrawn Commitments)
Aggregate Gross Exposure to Borrower (On + Off Balance Sheet)
Total Exposure to Borrower Consolidated Group (Including Affiliates)
Facility-Level Exposure and Security Package Detail
Facility Reference | Outstanding Amount | Primary Collateral Type | Latest Valuation | Valuation Date | Current LTV Ratio (%) | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | TL-A-2023 | $45,000,000.00 | Real Estate - Industrial | $65,000,000.00 | 9/30/2024 | 69.2 | |
2 | RCF-B-2023 | $15,000,000.00 | Accounts Receivable | $22,000,000.00 | 1/15/2025 | 68.2 | |
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Has there been any material adverse change in collateral value since last formal valuation?
Describe the valuation impact, methodology used for revaluation, and estimated current market value
Is an independent third-party appraisal required for any collateral asset?
Specify assets requiring appraisal, proposed appraiser, timeline, and cost
Assessment of Guarantor Support and Financial Strength (if applicable)
Proposed Risk Grade Classification Post-Waiver
Maintain Current Risk Grade
Downgrade by One Notch
Downgrade by Two Notches
Downgrade to Substandard
Downgrade to Doubtful
Place on Credit Watch Negative
Other Action
Will this request trigger a provisioning impact under applicable accounting standards?
Estimated Additional Provision Required
Overall Quality of Collateral Coverage and Mitigants
Inadequate - Significant shortfall
Weak - Below policy thresholds
Acceptable - Meets minimum requirements
Satisfactory - Adequate coverage
Strong - Well secured
Excellent - Over-collateralized
Key Credit Risks and Mitigating Factors
This final section consolidates the recommendation, risk assessment, and formal approval documentation required for Senior Credit Committee consideration.
Type of Accommodation Requested
Temporary Covenant Waiver Only
Payment Deferral (Principal and/or Interest)
Covenant Waiver + Payment Deferral
Covenant Reset (Permanent Amendment)
Forbearance Agreement
Other
Requested Waiver Effective Date
Requested Waiver Expiry Date
Duration of Waiver (Days)
Does the request include payment deferral?
Payment Deferral Schedule
Payment Type | Original Due Date | Proposed New Due Date | Deferred Amount | Interest Treatment During Deferral | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Principal Installment | 3/31/2025 | 9/30/2025 | $5,000,000.00 | Capitalize at facility rate | |
2 | Interest Payment | 3/31/2025 | 6/30/2025 | $450,000.00 | Payable on new date | |
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Relationship Manager Recommendation and Rationale
Proposed Conditions Precedent to Waiver Effectiveness
Updated financial projections and covenant model
Third-party collateral appraisal
Interim reporting requirements (monthly)
Restriction on additional debt incurrence
Restriction on dividend distributions
Minimum liquidity covenant
Additional guarantor support
Equity infusion by sponsor
Execution of forbearance agreement
Payment of waiver fee
Other
Proposed Ongoing Conditions During Waiver Period
Weekly liquidity reporting
Monthly financial reporting
Quarterly covenant testing
Restriction on capital expenditures above threshold
No material acquisitions without consent
Maintenance of minimum EBITDA levels
No change of control or management
Other
Recommended Approval Authority Level
Chief Credit Officer Delegated Authority
Senior Credit Committee (Standard)
Executive Credit Committee (Large/Complex)
Board Risk Committee (Exceptional)
Other
Key Risks and Mitigation Strategies for Committee Consideration
Has the borrower agreed to pay a waiver fee or increase pricing?
Waiver Fee Amount or Pricing Increase (bps)
Alternative Scenarios if Waiver is Not Granted
Upload Complete Credit Paper for Committee Review
Relationship Manager Certification and Recommendation
Credit Officer/Underwriter Concurrence and Risk Assessment
Chief Credit Officer Approval (if delegated authority)
Final Submission Timestamp
To configure an element, select it on the form.