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EMPLOYEE DISHONESTY BOND APPLICATION

 

Your Name:
Email:
Day Phone:
   

 

Applicant Information:
Applicant Name:
Business name:
Business Address :
City:
State:
Zip Code:
Business Phone:
Type of business
Purpose and function of business
Have you sustained any dishonesty losses in the last 6 years?
Amount of Bond
Term of Bond

 

Which of the two selection to the right best describes your company?

  

 Professional and business offices such as accountants, architects, physicians, dentists, insurance agents, and attorneys. (Officers are not covered under this bond, unless the insured is a corporation, and the officers are in the regular service of the insured and compensated by salary, wages, etc.)
Businesses with more exposure such as cafes, gas stations, retail stores, businesses with salespeople, non-profit social organizations (officers and employees - Note: Volunteers not covered unless endorsement added by Company) and courier services (except those handling cash and negotiable instruments).

 
Total # of Employees:
Total # of Owners/Officers:
Are Officers/Owners to be Covered?
Non-Profit Oranization?
Non-Profit Social Organizations ONLY:
(List officer positions)


 

If you are requiring a dishonesty bond over $50,000, please complete information below:
Countersignature of checks  required?
By whom?
How often is a complete audit done?
When was last audit done?
By whom was audit done?
Are bank accounts reconciled by someone not authorized to deposit or withdraw therefrom?
How often?

 

Comments:

  
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For your convenience, we are pleased to accept

 

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