Form Dfs H2 72 PDF Details

Are you looking to understand more about Form Dfs H2 72 and the regulations that surround it? As a business owner, being knowledgeable about applicable laws and regulations is part of your responsibility. Even if your business does not deal with hazardous materials or other dangerous goods, knowing the relevant rules could make all the difference in terms of running a smoothly-operating environment. Whether you are unfamiliar with this particular safety form or need a refresher on its details, we've got you covered! Read on to learn more about why H2 72 is essential for businesses that deal with hazardous substances.

QuestionAnswer
Form NameForm Dfs H2 72
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesDFS H2 72 surety bond florida dfs witness to principal must be signed form

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DEPARTMENT OF FINANCIAL SERVICES

Division of Agent & Agency Services – Bureau of Licensing

200 East Gaines Street, Larson Building Room 419

Tallahassee, FL 32399-0319

Public Adjuster’s Bond

Bond # ________________

KNOW ALL MEN BY THESE PRESENTS, That

 

 

, SS#

 

-

-

 

 

whose residence is

 

 

 

 

 

 

 

 

and

 

 

 

place of business is

 

 

, as Principal, and

 

 

 

 

 

 

 

as Surety are held and firmly bound unto THE DEPARTMENT OF FINANCIAL SERVICES OF THE STATE OF FLORIDA, or its successors in office, in the penal sum of Fifty Thousand ($50,000) dollars, lawfully money of the United States of America, for payment of which well and truly to be made, we bind ourselves, and our and each of our heirs, executors, administrators, successors and assign jointly and severally, firmly by these presents:

THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT the Principal, the above bounded

 

shall

faithfully comply with the conduct business under his/her license in accordance with the provisions of the public adjuster laws, Part VI of

 

Chapter 626, Section 626.851 through 626.878 Florida Statutes, and abide by all rules and regulations of THE DEPARTMENT OF FINANCIAL SERVICES as promulgated by the CHIEF FINANCIAL OFFICER. The obligation shall be null and void; otherwise, and it shall remain in full force and effect. This bond shall be in favor of the department and shall specifically authorize recovery by the department of the damages sustained in case the licensee is guilty of fraud or unfair practices in connection with his or her business as a public adjuster.

IT IS MUTUALLY AGREED AND UNDERSTOOD BETWEEN ALL PARTIES HERETO, that if the Surety shall so elect, this bond may be canceled and discontinued by giving thirty (30) days notice in writing to the Principal and filed with THE DEPARTMENT OF FINANCIAL SERVICES OF THE STATE OF FLORIDA, or its successors in office, by United States registered mail and this bond shall be deemed canceled at the expiration of the said thirty (30) days from the receipt of the said notice, the Surety remaining liable for all or any part of such premium receipts tax and other obligations covered by this bond, which may have accrued by default of the Principal prior to the effective date of the cancellation.

IN WITNESS WHEREOF the said Principal has caused these presents to be executed by affixing thereto his/her signature, and the said surety has caused presents to be executed by the signature of its attorney-in-fact and its corporate seal to be affixed hereto attested by its attorney-in-

fact this

 

 

day of

 

 

, year of

 

 

. This bond shall become effective on the

 

day of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

, year of

 

, and remain in force until canceled.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Surety (name of insurance company)

 

 

Principal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Witness to Principal

 

 

 

 

Attorney-in-Fact (signature)

 

 

(SEAL)

Print Name

Licensed General Lines Agent (Must be currently appointed by above

Surety)

LIC# ___________________________________________________

Street __________________________________________________

City____________________________________________________

State ____________________________ Zip Code_______________

NOTE: Attach to this bond a properly certified copy of the agent’s Power-of-Attorney. Signature of Principal MUST BE WITNESSED. Type below each signature the name of the person having affixed his/her signature. THIS BOND MUST BE COUNTERSIGNED BY A FLORIDA LICENSED GENERAL LINES AGENT OF THE SURETY.

DFS-H2-72 Revised 09/07

*NOTE

You are required by state and federal law to disclose your social security number on this application. Section 666(a)(13) of Title 42, Unites States Code, requires each state to obtain the social security number of each applicant for a professional or occupational license on the application for the license. Section 626.171(5), Florida Statutes, implements this federal law. The purpose of collecting social security numbers is for administration of the child support enforcement provisions of Title IV-D of the Social Security Act. The Department of Financial Services also uses social security numbers for identity verification purposes in conjunction with background checks of applicants and for identity verification purposes in the Department's electronic database for licensees and applicants.

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Step 2: The tool provides you with the ability to work with nearly all PDF forms in various ways. Change it by including your own text, adjust original content, and place in a signature - all when it's needed!

For you to fill out this PDF form, be certain to type in the necessary details in every field:

1. It is recommended to fill out the Form Dfs H2 72 accurately, so pay close attention while working with the areas including these specific fields:

Stage number 1 for submitting Form Dfs H2 72

2. The subsequent stage is usually to fill in all of the following blanks: KNOW ALL MEN BY THESE PRESENTS, Surety name of insurance company, Witness to Principal, SEAL, AttorneyinFact signature, Print Name Licensed General Lines, and NOTE Attach to this bond a.

NOTE Attach to this bond a, SEAL, and Print Name Licensed General Lines in Form Dfs H2 72

Always be extremely attentive while filling out NOTE Attach to this bond a and SEAL, because this is where a lot of people make a few mistakes.

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