Has applicant ever, (a) had an application for a bond declined; (b) compromised with creditors; (c) defaulted on a contract; (d) defaulted on a contract forcing a Surety to suffer a loss; (e) experienced a bankruptcy; (f) been in receivership or been liened by a taxing authority?
For Bonds Over $50,000: In order to provide you with the best competitive rate, we suggest completing a personal financial statement.
Completion of this application, constitutes permission for ProBond Insurance Corp and or surety to obtain a credit report for the individuals listed. Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime.
The quote you will receive is a conditional offer and is subject to change or rescission based upon a multitude of considerations. The above quoted may include a broker fee. Therefore, you hereby agree that if a fee is charged, to pay the fee in the amount shown. If the Bond is canceled midterm, the commission shall also be considered a fee, and fully earned. In addition, fees and premiums may earn interest. This undeclared income is non-refundable and fully earned as well as any fees charged.
In addition, ProBond Insurance, Corp. may also be acting on behalf of the insurer issuing the subject Bond(s) or insurance and will be receiving a commission. This agreement shall serve as the writing required pursuant to the rules set forth by your Department of Insurance (Broker/Agents shall comply with their applicable state regulations regarding fees). **Fees includes premium, processing, state tax, surplus tax, brokers and commission fee where applicable** All commissions and fees are fully earned upon the issuance of the bond(s).
By Clicking Submit You Are Acknowledging and Agreeing that you have read the above Terms & Conditions