Application Bond Form PDF Details

An Application Bond form is a critical document that serves various purposes across multiple fields, incorporating components like personal identity, business information, and financial statements. Designed to be versatile, it caters to a broad spectrum of needs, from public officials and fidelity bonds to probate and court bonds. The form meticulously collects applicant data, such as name, social security number, marital status, and contact details, ensuring thorough identification. It delves into business specifics for individuals, partnerships, corporations, and limited liability companies, requiring detailed financial disclosures to assess the applicant's financial stability. This assessment is crucial for the surety to estimate the risk involved in providing a bond. The form also outlines the conditions under which indemnity is required, emphasizing the importance of accuracy and full disclosure. The indemnity agreement is designed to protect the surety from potential losses, making clear the obligations of the applicant, such as premium payments and the provision of conclusive evidence terminating liability. Moreover, it provides guidelines for various entities on how to complete and sign the form, ensuring that all necessary information is provided accurately. This form is not just a formality but a comprehensive tool that facilitates the understanding and management of the risks associated with issuing bonds.

QuestionAnswer
Form NameApplication Bond Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namescna form 10, cna surety bond online, surety application for bond, cna surety application for bond

Form Preview Example

Signature & Business/Corporate Title

COMPLETE APPLICABLE SECTION ON REVERSE

Section Public Official . . . . . . . . . . . . 1

Fidelity . . . . . . . . . . . . . . . . . 2 Probate . . . . . . . . . . . . . . . . 3 Referee, Receiver, etc. . . . . . 4 Court . . . . . . . . . . . . . . . . . . 5 License . . . . . . . . . . . . . . . . 6 Lost Securities . . . . . . . . . . . 7

 

Individual

www.cnasurety.com

Partnership

Form 10

Corporation

Limited Liability Company

 

APPLICATION FOR BOND—ANY KIND

Limited Liability Partnership

Applicant Name (Exactly as shown on License or Bond) Please print or type

 

 

 

 

Social Security #

 

Date of Birth

Married

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Single

 

 

Residence Address

(Street and Number)

(City)

(State)

(Zip)

 

(Telephone #)

(Fax #)

(Email Address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Address

(Street and Number)

(City)

(State)

(Zip)

 

(Telephone #)

(Fax #)

(Email Address)

 

 

 

 

 

 

 

 

 

 

Occupation or Business

How long so engaged?

Previous Surety

 

 

 

Yes

 

No If yes, give name and reason for change.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Bond

Amount of Bond

Effective Date

Complete Name and Address of Obligee

FINANCIAL STATEMENT as of

 

 

 

 

 

 

 

 

Check applicable section on the reverse side to see whether a financial statement is necessary.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check one:

 

 

Business Financial Statement

 

Personal Financial Statement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ASSETS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIABILITIES

 

 

 

 

 

Cash (List Banks)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accounts Payable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Taxes due & accrued

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stocks + Bonds — Describe

 

 

 

 

 

 

 

 

 

 

Notes Payable to Bank

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Notes Payable to Others (Describe)

 

 

 

 

 

 

 

Notes Receivable — Describe

 

 

 

 

 

 

 

 

 

Mortgage on Real Estate

 

 

 

 

 

 

A

 

 

 

Merchandise or Material in Stock

 

 

 

 

 

 

 

 

Mortgage on Real Estate

 

 

 

 

 

B

 

 

 

Accounts Receivable

 

 

 

 

 

 

 

 

 

 

 

 

Other Liabilities — Describe

 

 

 

 

 

 

 

 

 

 

Real Estate, Homestead

 

 

 

 

A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Real Estate, Investment

 

 

 

 

B

 

 

 

 

TOTAL LIABILITIES

 

 

 

 

 

Furniture and Fixtures

 

 

 

 

 

 

 

 

 

 

 

Capital Stock (Paid in)

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Assets - Describe

 

 

 

 

 

 

 

 

 

NET WORTH OR SURPLUS

 

 

 

 

 

 

 

TOTAL ASSETS

 

 

 

 

 

 

 

TOTAL Liabilities and Net Worth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gross Sales - Two Years Ago

 

 

Last Year

 

 

Net Income - Two Years Ago

 

 

Last Year

 

INDEMNITY

The undersigned applicant and indemnitors hereby request Western Surety Company, Universal Surety of America, Surety Bonding Company of America and any affiliated company, their successors or assigns (with such company/companies referred to herein as the "Company") to become their surety. The undersigned hereby certify the truth of all statements in the application, authorize the Company to verify this information at the time of application and as needed, on an ongoing basis and to obtain additional information from any source, including obtaining credit reports at the time of application, in any review or renewal, at the time of any potential or actual claim, or for any other legitimate purposes as determined by the Company in its reasonable discretion, and jointly and severally agree:

( 1) To pay premiums, including renewal premiums and any other charges, to the Company or its agents, when due,

(2) To completely INDEMNIFY the Company from and against any liability, loss, cost, attorneys' fees and expenses whatsoever which the Company shall at any time sustain as surety or by reason of having been surety on this bond or any other bond issued for any applicant and or indemnitor, or for the enforcement of this agreement, or in obtaining a release or evidence of termination under such bonds, regardless of whether such liability, loss, costs, damages, attorneys' fees and expenses are caused, or alleged to be caused, by the negligence of the Company,

( 3) To furnish the Company with satisfactory and conclusive termination evidence that there is no further liability on this bond or any other bond issued for applicant,

( 4) Upon demand by the Company for any reason whatsoever, to deposit current funds with the Company in an amount sufficient to satisfy any claim against the Company by reason of such suretyship,

(5) That the Company shall have the right to handle or settle any claim or suit in good faith and the Company's decision shall be binding and conclusive on the undersigned. An itemized statement of loss and expense incurred by the Company, shall be prima facie evidence of the fact and extent of the liability of the undersigned to the Company,

( 6) That the Company may decline to become surety on any bond and may cancel or amend any bond without cause and without any liability which might arise therefrom,

(7) That the Company shall, without notice, have the right to alter the penalty, terms and conditions of any bond issued for undersigned, and this agreement shall apply to any such altered bond. The liability for the undersigned shall not be affected by the failure of the undersigned to sign any bond, nor any claim that other indemnity or security was obtained, nor by the release of any indemnity, nor the return or exchange of any collateral obtained and if any party signing this agreement is not bound for any reason, this agreement will still be binding on each and every other party

(8) That if a contract or performance bond is issued hereunder, the undersigned hereby assign to the Company any monies now due or hereafter becoming due under the contract, including all deferred payments and retained percentage, supplies, tools, plants, equipment and materials due or used on the contract,

(9) At the Company's discretion, this indemnity agreement shall be governed in all respects by the laws of the State of South Dakota and the undersigned applicant and indemnitors consent to the jurisdiction of the courts of the State of South Dakota and the United States District Court for the District of South Dakota in all actions or proceedings arising from or relating to this indemnity agreement,

(10)That this indemnity may be terminated by the undersigned, or any one or more parties so designated, upon written notice sent registered mail to the office of the Company at Sioux Falls, South Dakota 57104, of not less than twenty (20) days. In no event, shall any termination notice operate to modify, bar, discharge, limit, affect or impair the liability of any party hereto, for any bonds, undertakings and obligations executed prior to the date of the Company's receipt and notice of such termination

(11) In the event of any payment by the Company, to pay the Company interest on such amounts

Signed this

 

day of

 

,

at the highest legal rate from the date such payments are made.

 

 

 

 

 

Agency

Address

Street

City

State

Zip

Agent's Code

AGENT'S RECOMMENDATION

Your recommendation will be helpful and may be the difference between getting a refusal or having the bond written. Tell us what you know and think of the applicant.

"Indemnitor"

"Indemnitor"

"Indemnitor"

Note: Personal indemnitors should print and sign their names before the word "indemnitor" in their

own handwriting, e.g. John Doe

"Indemnitor"

AGENT: Check here if this correspondence was previously faxed or emailed to CNA Surety.

Form 10-1-2010 © WSCo. 2010

Is applicant indebted to the estate
or trust? Yes No (If yes, explain on an attached sheet.)
Telephone #

IMPORTANT NOTICE

Please discuss with the principal the potential use of personal credit history to facilitate the underwriting review process.

1

2

PUBLIC

OFFICIAL

BOND

NO FINANCIAL STATEMENT

NECESSARY.

HAVE PRINCIPAL SIGN APPLICATION IF $75,000

OR MORE.

FIDELITY

BOND

NO FINANCIAL STATEMENT

NECESSARY.

Net Worth:

 

Elected

 

 

 

 

 

Date:

 

Term of Office:

 

 

Premium will be paid:

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Annually?

 

 

 

for term?

 

 

Appointed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title of Position

 

 

 

 

 

 

 

 

 

 

Main Sources of Organization's Funding

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Purpose or Function of Organization

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Annual Salary

Will applicant sign

 

 

 

Is countersignature required?

 

 

Yes

 

No

 

Regular audits?

 

 

Yes

 

 

No

 

checks?

 

Yes

 

No

By whom?

 

 

 

 

 

 

 

 

By whom?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are bank accounts reconciled by someone not authorized to deposit

Ever discharged from any employment?

 

 

Yes

 

 

 

 

No Why?

 

or withdraw from the accounts?

 

Yes

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last position held?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How long in present

 

 

 

Applicant's net worth:

Reason for leaving?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

position?

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of deceased (Ward)

Date of death

Date of appointment (If over 6

 

 

 

 

 

 

 

months, please explain delay.)

 

 

 

 

 

 

 

 

 

 

 

 

 

3

4

5

6

7

PROBATE

BOND

NO FINANCIAL STATEMENT

NECESSARY.

HAVE PRINCIPAL SIGN

THIS APPLICATION.

REFEREE'S

RECEIVER'S

TRUSTEE'S

BOND

NO FINANCIAL STATEMENT

NECESSARY.

HAVE PRINCIPAL SIGN

THIS APPLICATION.

COURT BOND OTHER THAN 3 AND 4

FINANCIAL STATEMENT

NECESSARY.

HAVE PRINCIPAL SIGN

THIS APPLICATION.

LICENSE AND PERMIT BOND

FINANCIAL STATEMENT NECESSARY WHERE STATE IS THE OBLIGEE.

HAVE PRINCIPAL SIGN

THIS APPLICATION.

LOST SECURITIES/

CERTIFICATE

OF TITLE BOND

FINANCIAL STATEMENT

NECESSARY.

HAVE PRINCIPAL SIGN

THIS APPLICATION.

Has applicant had prior possession of estate assets?

 

Yes

 

No If yes, please explain.

Name and address of attorney (If none, do not write the bond; submit it to our underwriters.)

Will the attorney remain involved throughout the

Assets of estate or trust (describe)

 

 

 

 

 

 

 

duration of this estate?

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name, age, and health status of

 

 

 

 

 

 

 

 

Applicant's relationship to

 

Applicant's net worth:

 

 

 

minor(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

deceased

 

 

$

 

 

 

 

 

 

 

incompetent

 

 

 

 

 

 

 

 

 

 

 

 

 

ward(s)

 

 

 

 

 

 

 

Are guardianship funds to be used for support of ward?

 

 

 

 

 

 

What is the source of the guardianship funds? (If an insurance settlement,

 

 

 

 

Yes

 

No Approximately how much per month?

 

 

 

 

 

 

 

do not execute the bond; instead refer it to an underwriter.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Please

send

copy of court order authorizing monthly expenditures.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Who are the heirs of this estate?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Has anyone objected to the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

applicant's appointment as fiduciary?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

No

Will any going business (excluding farms) of the estate be continued

 

 

 

Is this bond required on the demand of an interested person?

 

by fiduciary? (If yes, send a copy of court order.)

 

 

Yes

 

No

 

 

 

 

 

Yes

 

No Who?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and address of court:

What is the applicant's experience in handling fiduciary responsibilities?

Plaintiff

Name and address of principal's attorney

 

 

 

 

 

 

 

 

 

 

 

 

Defendant

Name and location of Court

 

 

 

Applicant's net worth:

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and location of Court

 

Name of Defendant

 

 

 

 

 

 

 

 

Name and address of attorney

 

If an Injunction or Restraining Order bond, does applicant

 

 

anticipate a foreclosure or collection action against him?

 

 

 

Yes

 

No

If so, submit for underwriting.

Explain purpose of bond (submit copy of relevant documents)

Net worth:

 

 

General liability insurance carried?

 

Yes

 

 

No

State license number assigned to applicant, if applicable:

$

 

 

 

 

 

(Give limits)

 

 

 

 

 

 

 

#

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Serial Number and description (Please submit a copy or sample of the

 

 

 

Date of instrument

Payable to applicant only?

 

 

 

Yes

 

 

 

No

form it was on.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If not, who is it payable to?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are securities endorsed?

Describe manner of loss

 

 

 

 

 

 

 

 

Has notice of loss been given?

 

 

 

Yes

 

 

 

 

No

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When?

To Whom?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If registered, in whose name?

 

If a check, has payment been stopped?

 

 

 

If a deed of trust or note, has either been involved in a lawsuit?

 

 

 

 

 

 

 

 

 

 

 

 

No If so, when?

 

 

 

 

Yes

 

 

No Was a judgment obtained?

 

 

Yes

 

 

No

 

 

 

 

 

 

 

 

 

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Make

 

 

 

 

 

 

Vehicle Model

 

 

 

 

 

Vehicle Year

 

Vehicle VIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is there a lien or lien holder?

 

 

Yes

 

No If yes, list and explain.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CNA is a registered service mark, trade name and domain name of CNA Financial Corporation. No part of this material, including the CNA Surety logo, may be reproduced

without written permission from CNA Surety Corporation.

P.O. Box 5077

1-800-331-6053 FAX 1-605-335-0357

Sioux Falls, South Dakota 57117-5077

www.cnasurety.com

 

 

Guidelines for Completing and Signing a Form 10 Application For

Bond—Any Kind and Form 10-E—Easy Application

1

2

HELPFUL HINTS

a)INDIVIDUAL OR SOLE PROPRIETORSHIP—The individual or sole owner and spouse should sign Section Two 2 before the word "Indemnitor". When providing financial statements, separate business and personal statements are preferable.

b)PARTNERSHIP—Each partner and his or her spouse should sign Section Two 2 before the word "Indemnitor". If additional personal indemnity is required, the individual may sign their name and write the word "Indemnitor" after their name in their own handwriting. When providing financial statements, send a financial statement for the partnership along with personal statements for each partner.

c)CORPORATION—An officer should first sign Section Two 2 on behalf of the corporation (indicating his/her corporate title; however, "owner" is NOT an acceptable title) and then sign a second time as a personal indemnitor, before the word "Indemnitor". All other owners should also sign as personal indemnitors before the word "Indemnitor" on each line. *In most cases, the owners' spouses also need to sign. If additional personal indemnity is required, the individual may sign their name and write the word "Indemnitor" after their name in their own handwriting. When providing financial information, supply a corporate financial statement along with individual financial statements and current addresses for the owners.

d)LIMITED LIABILITY COMPANY (LLC) OR PARTNERSHIP (LLP)—An authorized manager, member, or partner should first sign on behalf of the Limited Liability Company or Partnership (indicating his/her company/partnership title; however, "owner" is NOT an acceptable title) and then sign a second time as a personal indemnitor, before the word "Indemnitor". All other members/owners/partners should also sign as personal indemnitors before the word "Indemnitor" on each line. In most cases the members'/owners'/partners' spouses also need to sign. If additional personal indemnity is required, the individual may sign their name and write the word "Indemnitor" after their name in their own handwriting.

e)OUTSIDE INDEMNITY (Relatives, Friends, etc.)—When outside

indemnity is required, the proposed indemnitors should sign Section Two 2 below the applicants' signature(s) and before the word "Indemnitor". If additional personal indemnity is required, the individual may sign their name and write the word "Indemnitor" after their name in their own handwriting. The outside indemnitors should provide their personal financial statements and current addresses.

We have examples showing five ways to sign an application.

a) INDIVIDUAL OR SOLE PROPRIETORSHIP

Complete Section One 1 in the Individual's name showing the business trade name, if there is one, e.g. John Doe DBA Doe Company.

2 Signed this

 

day of

 

 

,

 

 

 

 

 

 

 

Signature & Business/Corporate Title

"Indemnitor"

 

 

 

 

 

 

 

 

 

 

"Indemnitor"

NOTE: Personal indemnitors should sign their names before the word "indemnitor".

b) PARTNERSHIP

Complete Section One 1 using the full names of all partners indi- cating the business trade name, e.g. John Doe and James Doe DBA Doe Company.

2 Signed this

 

day of

 

 

,

 

 

 

 

 

 

 

Signature & Business/Corporate Title

"Indemnitor"

 

 

 

 

 

 

 

 

 

 

"Indemnitor"

 

 

 

 

 

"Indemnitor"

NOTE: Personal indemnitors should sign their names before the word "indemnitor".

c)CORPORATION

Complete Section One 1 using the name of the corporation only, e.g. Doe Corporation, Inc.

2 Signed this

 

day of

 

,

 

 

Signature & Business/Corporate Title

"Indemnitor"

"Indemnitor"

*"Indemnitor"

*

NOTE: Personal indemnitors should sign their names before the word "indemnitor".

*In some cases the owners' spouses may also need to sign.

d)LIMITED LIABILITY COMPANY (LLC) OR PARTNERSHIP (LLP) Complete Section One 1 in the name of the limited liability company or partnership only, e.g. Doe Company, LLC or Doe Company, LLP.

2

Signed this

 

day of

 

 

,

 

 

 

 

 

 

 

 

 

Signature & Business/Corporate Title

"Indemnitor"

 

 

 

 

 

 

 

 

 

 

 

 

"Indemnitor"

 

 

*

"Indemnitor"

 

 

 

 

 

 

 

*

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: Personal indemnitors should sign their names before the word "indemnitor".

* In some cases the members/owners'/partners' spouses may also need to sign.

e) OUTSIDE INDEMNITY (Relatives, Friends, etc.)

Complete Section One 1 in the applicant's name following (a), (b) or (c) above.

2 Signed this

 

day of

 

 

,

 

 

 

 

 

 

 

Signature & Business/Corporate Title

"Indemnitor"

 

 

 

 

 

 

 

 

 

 

"Indemnitor"

 

 

 

 

 

"Indemnitor"

NOTE: Personal indemnitors should sign their names before the word "indemnitor".

NOTE: Financial statements may be submitted on the FORM 10 APPLICATION or on CNA Surety's Form #60—Financial Statement. Copies of Bank or Accountant prepared financial statements are also acceptable.

Form 1509-6-2008

Cancellation Guidelines

To assist in understanding the numerous and diverse rules for bond cancellations, we have developed the following guidelines. There are many exceptions to the rules, so please contact your underwriting office with any specific questions.

1.First year premiums are usually considered fully earned.

2.Bonds that renew with a renewal bond or continuation certificate (in other words they're not continuous in nature) are cancellable upon the return of the original bond, renewal bond or continuation certificate. In the absence of the original renewal document, send written verification from the obligee (state, county, city, etc.) that the bond was not filed or used.

3.Many continuous bonds contain a cancellation clause which allows us to send notice of cancellation or nonrenewal to the obligee. Our notice must comply with the terms of the cancellation clause and conform to any applicable state laws. You can normally determine if there is a cancellation clause by reading the bond form.

4.Some continuous bonds do not contain a cancellation clause, so the only way we can cancel them is upon receipt of a letter of release from the obligee. The obligee's letter should state the principal's name, bond number, and the date our liability is considered terminated.

5.Probate Bonds usually require a court order to terminate our liability. Send us a copy of the Final Order of Discharge to cancel this type of bond.

6.Public Official Bonds written to coincide with a term of office require a signed letter of release from an official of the jurisdiction. That official must have the proper authority to release the bond.

7.Many state laws have been enacted in recent years which restrict us from effecting cancellation or nonrenewal except under specified circumstances. Providing us with a reason for cancellation is helpful for determining if we are allowed by law to do so.

Please contact your underwriting office if you would like to have any of these rules explained in more detail or if you have a question about how the above rules affect a specific bond.

P.O. Box 5077

Sioux Falls, SD 57117-5077

1-800-331-6053

Fax 1-605-335-0357

CNA is a registered service mark, trade name and domain name of CNA Financial Corporation. No part of this material,

including the CNA Surety logo, may be reproduced without written permission from CNA Surety Corporation.

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