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Surety Solutions A Gallagher Company

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ERISA Bond Application

If your Personal Administrator is Benetrends, please complete and submit our Benetrends ERISA Fidelity Bond Application here.

ERISA Bond Application

Surety Solutions, A Gallagher Company ERISA Bond Application. Get your ERISA Bond starting as low as $100.

Please select an effective date for the ERISA Bond.*
Please note the effective date of the bond cannot be backdated more than 70 days or postdated 2 weeks from today's date.
MM slash DD slash YYYY
Please select the bond amount you require.*
Bond amount must be for at least 10% of Qualified Plan Assets.

All our ERISA Bonds under $500,000 include "Inflation Guard", so you will remain in compliance with the U.S. DOL during your full bond term. No increase in premium if your plan funds increase mid-term.
What is the name of the plan?*
(exact name of Plan to be covered)
What is the name of your company?*
What is the company's address?*
Street Address Address Line 2 City State ZIP Code
What's the plan holder's name?*
First Last
What is your phone number?*
What is your email address?*
Enter Email Confirm Email
Is the plan holder's address different than the company's address?*
- Yes
- No
What is the plan holder's address?*
Street Address Address Line 2 City State ZIP Code
Is the name of the plan sponsor different than the name of the plan?*
- Yes
- No
What is the plan sponsor's name?*
What is the plan sponsor's address?*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Is the plan audited annually by a CPA?*
- Yes
- No
What is the name of the CPA firm?*
What is the address of the CPA firm?*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Does an independent administrator service the plan?*
- Yes
- No
What is the name of the administrator?*
Please note Independent Administrators will not be covered under bond.
How many trustees are there for the plan?*
Please enter a number greater than or equal to 1.
What is the value of the qualified plan assets?*
Bond amount must be for at least 10% of the Qualified Plan Assets.
In what state are the funds held?*
Has the sponsor or have any of the applicant's plans experienced any prior or pending fidelity/dishonesty loss?*
- Yes
- No
Has the sponsor or have any of the applicant's plans been declined coverage by another insurance company?*
- Yes
- No
Is the Sponsor of any of the applicant's plans a union?*
- Yes
- No
Do any of the applicants plans contain non-qualifying assets?*
- Yes
- No
What is the value of the non-qualified plan assets?*
Bond amount must be for 100% of the Non-Qualified Plan Assets.
Who reconciles plan's bank statement?*
Who deposits funds in plan's accounts?*
Do any of the applicant's plans contain employer securities?*
Employer securities refer to shares of stock, bonds or debentures issued by a corporation with interest coupons or in registered form.
- Yes
- No
Is the required bond amount over $500,000?*
- Yes
- No
Is there more than one plan needing coverage?*
- Yes
- No
Please list additional plans*
(Exact name of the additional plan(s) to be covered)

Please note: A separate application for each additional plan must be filled out and submitted, as each plan requires its own bond.
Were you referred to us by Arthur J. Gallagher & Co.?*
- Yes
- No
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What is today's date?
MM slash DD slash YYYY

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Contact Surety Solutions, A Gallagher Company

Email: [email protected]

4285 Commercial Street SE
Suite 110
Salem, OR 97302

(866) 722-9239

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