Judicial Bond Application
for New York
Applying for a bond is like applying for credit, therefore, please provide the following:
   
This Online form is on a Secure Server. Click on the seal located on left for more information on the certificate's authentication. Privacy Statement: Any information provided by a consumer or customer via our online forms WILL be held in the strictest confidence. No information will be shared with others. All submissions will be responded to within 24 hours.
         
  • Application Please make sure this information is complete and legible.
  • Company financial statements (if applicable) Please provide the latest fiscal year end statements and current interim statement if over six months old.
  • Personal financial statements All owners must provide a personal financial statement.
  • Court documents Please provide all pertinent court documents to assist in our prompt underwriting.

    • Applicant Information *required field        

    Applicant (Principal)    Email*   
    Principal's Address    City    State    Zip   
    Date Business Began    SSN or Tax ID #    Phone    Occupation or industry   
    If Applicant is a Privately-held company; Owner's Full Name    Owner SSN   
    Owner's Home Address    Owner Home Phone   
    Primary Bank    Lines of Credit?  YES  NO   If yes, Amount $   
    Applicant's Attorney    Attorney Phone   
    Attorney Address    City    State    Zip   
    Exact Title of Case   
    Bond to be filed in the Court of County, State of  
    Amount of liability, claim judgment and/or value of property in controversy $   
    Bond Amount $    Type of Bond Requested   
    Explain Purpose of Bond   
    Does applicant have outstanding collection items/liens? Y N Is applicant involved in any other lawsuits? Y N
    Does applicant currently have judgments against them? Y N Has applicant ever failed in business/declared bankruptcy? Y N
    Has applicant had license or bond cancelled or denied? Y N  

     

    Agency Contact Agency Recommendation

    Agency:    We are not familiar with the applicant  
    Contact:    Applicant has been referred to us for bond placement  
    Address:    The agency writes all Applicant's insurance and we highly recommend  
    Phone: 
       Fax: 
    		  Other  
    Mobile:   
    Email: 
    		 

     

    Consumer Notification:
    As part of the application and underwriting process: This is to inform you that a consumer report or an investigative consumer report may be obtained by the bonding company from a Consumer Reporting Agency for the purposes of reviewing and determining your eligibility for a surety bond. This report may contain information bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living from public record sources or through personal interviews with your neighbors, friends or associates. As agents of the bonding company we do not see this information nor do we as agents make any decisions based on the information. All underwriting decisions rest with the bonding company underwriter. A copy of the credit information may be obtained directly from the Consumer Reporting Agency which complied and released the information to the bonding company.

    I have read and agree to the bonding company obtaining this report. (* required)

    Fraud Warning:
    Any person completing or filing an application to a surety, insurance company or their agents, for the purpose of obtaining bonding or insurance, knowingly, with the intent to defraud, mislead or induce, make materially false, incomplete or misleading information, or conceal information concerning any material fact, commits a fraudulent act which if convicted is a crime punishable by incarceration and subject to civil penalties as governed by the jurisdiction and applicable State and Federal statutes.

    The Fraud Warning has been read and the Application Completed by (* required)

    I have answered all questions above truthfully to the best of my knowledge.
      (please check box before submitting)