Woodland South Capital — Funding Request and Borrower Certification

Funding Request and Borrower Certification Form

Contact

Draw Request

Documents

Certification

Contact Information

Please provide your contact details and company information below.

First name *Please enter a valid first name.

Last name *Please enter a valid last name.

Email *Please enter a valid email address.

Phone number *Phone number must contain only digits, spaces, +, (, ), or -.

Company *Please enter a company name.

Title *Please enter your title.

Draw Request

Select whether you are requesting funding at this time, or submitting a compliance certification only.

Funding Requested

I am requesting a draw from my facility at this time.

No Funding Requested

Certifying Compliance Only — no draw at this time.

Compliance-Only Certification. You will still complete and sign the reps and warranties in the next steps. No draw amount will be submitted.

Requested draw amount *

Please enter a valid numeric amount.

Requested availability date *Please select a valid availability date.

Intended use of proceeds * Please select an intended use of proceeds.

Additional notes

Supporting Documentation

Upload any documents relevant to this funding request. Accepted: PDF, JPG, PNG, XLSX (max 25 MB each).

Click to upload files

or drag and drop here

Certification & Signature

Review the compliance certification below, confirm each statement, and sign.

I, [Officer Name], hereby certify on behalf of [Company] that:

1. I am a duly authorized officer of the company and am authorized to submit this certification.

2. The use of proceeds from this draw request complies in all material respects with the terms and conditions of the applicable loan agreement, credit facility, or other financing documents governing this facility.

3. No event of default has occurred or is continuing, and no condition exists that, with notice or lapse of time, would constitute an event of default.

4. All representations and warranties made in the loan documents remain true and correct in all material respects as of the date hereof.

I confirm that I have read and understood the certification statement above.

I confirm that the use of proceeds for this draw request is permitted under the applicable loan documents.

I confirm that no event of default has occurred or is continuing as of the date of this certification.

Data consent *

I consent to Woodland South Capital collecting, storing, and processing my personal data submitted in this form for the purpose of managing my loan facility. I understand I may request access to or deletion of my data at any time by contacting my relationship manager.

Signatory Name *

Date

Signature *

Sign here using mouse or touch

Certification Submitted

Your borrower certification has been received by Woodland South Capital and logged in our system. Your relationship manager will follow up shortly.

Reference — WSC-XXXXXX