SHORT FORM APPLICATION - ALIGNED Insurance
| QUICK WRITE APPLICATION |
|COMMERCIAL SURETY |
|No Signature or Financial Statements Required |
|Up to a Maximum of $50,000.00 |
|IF EXPOSURE IS OUTSIDE CANADA, PRINCIPAL IS A NON-RESIDENT, OR THE TOTAL BOND EXPOSURE EXCEEDS $50,000.00, THIS SHORT FORM APPLICATION DOES NOT APPLY; THE COMMERCIAL|
|BOND APPLICATION WILL NEED TO BE COMPLETED. |
|IMPORTANT: IF THE BOND IS ISSUED BY THE BROKER, PLEASE RETURN THIS APPLICATION WITH A COPY OF THE BOND WITHIN 24 HOURS. |
|1. DETAILS ON BOND REQUIRED: | |Bond Amount: $ | |
| | | | | | |
| |Customs | |Automobile Dealer Bond | |Auctioneers License Bond |
| |Activity Conducted at: | |(Maximum $25,000.00) | |Bailiffs Act Bond |
| | All Customs offices in Canada | |Quarry and Sand-Pit | |Consumer Protection (N-25) |
| | Other:| | |(Quebec Only) |
| | | |Number of Acres: | | |
| | | | | | |
| |Excise | |Lot Number: | | |
|Excise Regional office of: | | | | | |
| | | | | |Other (for other types call for |
| | | | | |approval) |
|Name & Address of Obligee: |
| |
|Bond Number: | |Effective Date | |Premium: $ | |
|Amount: $ |Term (Year / Month): | | |
|2. INFORMATION ON THE APPLICANT | |
|Name of Applicant**: | |
|Address: | | |Postal Code: | |
|Type of Business: | | |Telephone: |( ) |
|Name Owner/Shareholder Contact: | |
|Home Address: | | |Postal Code: | |
|Email Address: | | |
|Have the applicant, its officers or spouse or a related company ever gone bankrupt, made a proposal (under bankruptcy act) or produced |
|a loss to a Surety? |Yes |No |
|If yes, give full details on a separate sheet and communicate with us before issuance. |
|** Name that should appear on the bond. | |
|3. INFORMATION ON THE BROKER | |
|Name: | |Agency Number: | |
|Contact: | |Telephone : |( ) |
| | | | |
|How long have you known the applicant: | |
|To the best of my knowledge, the information is correct and I am recommending the issuance of the bond. |
|Dated: | | | |X | |
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|BROKERS COMMENTS: |
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|Our Commercial Surety Team is proud to offer professional services throughout Canada |
|Our staff is always available to serve you in regards to your bonding needs |
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| | |TORONTO – HEAD OFFICE | | |
| | |Tel: (416) 223-9580 | | |
| | |Fax: (416) 223-6577 | | |
| | |toronto@ | | |
| |MONTREAL |QUEBEC |VANCOUVER | |
| |Tel: (514) 866-6351 |Tel: (418) 652-1676 |Tel: (604)687-7688 | |
| |Fax: (514) 866-0157 |Fax: (418) 652-9626 |Fax: (604) 687-8861 | |
| |montreal@ |quebec@ |vancouver@ | |
| |EDMONTON |WOODSTOCK |HALIFAX | |
| |Tel: (780) 424-2266 |Tel: (519) 539-9868 |Tel: (902) 424-4700 | |
| |Fax: (780) 424-3310 |Fax: (519) 539-5524 |Fax: (902) 425-4702 | |
| |edmonton@ |woodstock@ |halifax@ | |
| |
|FOR INTERNAL USE ONLY |
|Amount: | | |Type: | |
| | | | | |
|Total Amount: | | |By: | |
| | | | | |
| | | | |PR: |
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