Insurance Broker Bond

Insurance broker bonds are finance license bonds that guarantee that insurance agents and brokers will follow state mandated rules. This bond is needed for insurance companies, brokers, and agents in order for them to obtain an insurance broker license. Because giving out personal information to insurance agents can be risky to some people, this bond will allow them to rest assured that they are receiving a fair policy at all times. Insurance brokers will be unable to five inflated quotes to increase profit, or to force buyers to purchase inappropriate plans. It also protects the buyer from the risk of being coerced into misrepresenting themselves on any documents.

The prices of insurance broker bonds prices are based off of a portion of the total bond amount.  Some states might require insurance broker bonds for entire insurance companies, which guarantee all agents. Some states might also require a bond per broker per producer. State bonds tend to vary, so interested parties should make sure they check with their state agency before they make a decision on a bond.

Insurance adjusters, insurance agents, surplus lines brokers and third party administrators all may need to be bonded in order to obtain a license. Again, because all states have different policies or regulations, it is a good idea to check with the state office to see what must be purchased.

Insurance broker bonds must be held as long as the broker is in business in order to maintain an actice license.


Application for


Current or expiring quote we are looking to beat:


Name of previous surety company writing to the bond:


Section I: Bond Applied for

Type of Bond

Effective Date

Expiration Date


Type of Company

CORP

LLC

DBA

Partnership

Bond Amount


(Obligee)


Obligee Address


Section II: General Information

Applicant's Name

Spouse Name


SS#

Spouse SS#

Home Phone


Residence Address

City

State

Zip


Status of Residency

Own

Rent

At Current Address Since


Date of Birth

Spouse Date of Birth

Business License Number


Business Name


Business Phone

Business Fax

Business Email


Business Address

City

State

Zip


Date Business BEGAN Under Present Individual or Firm Name

Business Tax ID


Has any company refused to issue bonds for any purpose?

Yes

No

Do you have any liens, claims or judgements against you?

Yes

No


Has applicant ever failed in business?

Yes

No

Has applicant filed bankruptcy in the last 10 years?

Yes

No


If yes, Chapter 7?

Yes

No

Chapter 11?

Yes

No

Chapter 13?

Yes

No


Date Filed for Bankruptcy?


Date of Discharge?


If yes to any, please explain:


Section III: Additional Parties

Name

Spouse Name


SS#

Spouse SS#

Home Phone


Home Address

City

State

Zip


Personal Financials

(if more than one owner, each has to fill out this app)

Statement of assets and liabilities as of


Assets Liabilities
Cash in Bank Notes Payable to Banks
Cash on Hand Notes to Others(excl. of equipment)
Stocks and Bonds Accounts Payable
Accounts Receivable Federal and State Income Tax Due
Notes Receivable All Other Taxes
Inventory Accruals, Payrolls, Etc.
Cash Value Life Insurance    
Equipment Due on Equipment
Real Estate Due on Real Estate
Other Assets Other Liabilities
    Surplus and Undivided Profits
    Capital Stock(if a corporation)
       
Total Assets Total Liabilities

Net Worth


Name of Owners

Name and Title of Officers

% of Ownership


Are you an insurance agent?

Yes

No

Agent License #

Agent State

Completion of this form constitutes permission for Cal Society Insurance Services to obtain customer information which will be used to determine bonding eligibility. This information will be held in the strictest confidence.