Surety Bond Form

Applicant Name*
Business Name "DBA"
Home Address*
City*
State
Zip*
Business Address*
City*
State*
Zip*

Email*

Phone*

Fax

Social Security No.

# Years as Immigration Consultant

Effective Date of Bond

Are you a U.S. Citizen?	Yes No
Have you ever experienced a claim, surety loss or legal action against your immigration consultant bond?	Yes No
Do you or any of your companies have any pending lawsuits and/or prior judgments?	Yes No
Do you or any of your companies have any past or present tax liens?	Yes No
Have you or any of your companies declared bankruptcy or become insolvent?	Yes No
Have you ever been convicted of a felony?	Yes No

Indemnification Agreement – Read Carefully and Sign
In consideration of the execution, renewal, assumption, continuation, or reissuance of a bond or bonds for the undersigned, or either of them (collectively, the “Undersigned”), the Undersigned promise and agree, jointly and severally, with SureTec Insurance Company, SureTec Indemnity Company, and/or any other surety executing or renewing a bond for the Undersigned at the request of either of them (collectively, “Surety”), as follows:
1. That, all information provided herein is represented by Undersigned is true and correct.
2. To reimburse, hold harmless, and indemnify Surety upon demand for all loss, liability, claim, expense, including but not limited to attorney’s fees, expert’s fees, investigative fees and claims handling fees, and any other cost which Surety shall pay or incur in defense, adjustment, or settlement of such claims/suits by reason of such suretyship, whether or not Surety shall have paid same at the time of demand.
3. That, Surety has the exclusive right to determine whether or not any claim or suit shall be paid or compromised.
4. To pay Surety an advance premium for the first year upon execution of the bond and to pay premium annually until such time that bond liability is extinguished.
5. That the place for performance of this agreement, including the promise to pay Surety, as well as venue for any action to enforce same shall be in Los Angeles County, California. Surety shall be entitled to recover its reasonable attorney’s fees incurred in the enforcement of this agreement. That, Surety is authorized to investigate, at any time, the undersigned’s credit, references, employment history and Department of Motor Vehicle records.
6. That, the Undersigned grant to Surety a security interest in and to all equipment, inventory, receivables, accounts, and intangibles of the Undersigned to secure Surety against loss.
7. That, we may do business electronically with the undersigned and that, any signature via fax, email, text message, click through endorsement, electronic or otherwise, by the Undersigned or his/her/its agent, shall be binding on the Undersigned.
Signed this day ,
Individual Signature Print Name

All Above Fields are Required and need to be Completed

$100,000 Immigration Consultant Bond Application