Fidelity Bond Application If your business is in Georgia State, please fill out our Georgia Fidelity Bond application here. Step 1 of 2 50% What type of Fidelity Bond would you like to apply for?* Theft Guard Standard – Protects you AND your clients from dishonest acts by employees (This bond contains a conviction clause) Theft Guard Pro – Protects just your business from dishonest acts by employees Theft Guard Janitorial – Protects just your clients from dishonest acts by your employees, usually when your employees are entering the homes/premises of your clients (This bond contains a conviction clause) (Can be for any type of business, not just janitorial) If you are unsure what type of policy you need, please read this article.Please choose an effective date for your bond.* MM slash DD slash YYYY How much coverage are you applying for?* $5,000 $10,000 $25,000 $50,000 $100,000 How much coverage are you applying for?* $5,000 $10,000 $25,000 $50,000 What is the name of your business?* What is your business' address?* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What is your name?* First Last Are you the business owner?* Yes No Is there more than 1 business owner?* Yes No What is the business owner's name?* Please list all business owners.*(e.g. John Smith, Jane Doe, etc…)What is your phone number?What is your email address?* Enter Email Confirm Email What is your company type?* Corporation Sole Proprietorship General Partnership Limited Partnership Limited Liability Company (LLC) Association Are you a Registered Investment Advisor (RIA) working with Charles Schwab?* Yes No Charles Schwab requires RIA's Fidelity Bonds include Social Engineering coverage.Please continue to be redirected to our application that includes this coverage. Your responses from this form will auto-populate on the new application. Have you had any employee dishonesty losses in the last 5 years?* Yes No Please explain the details of the employee dishonesty losses you've had in the last 5 years.*How many TOTAL individuals will be covered under this policy?*(Include all full and part-time, owners/officers, volunteers and independent contractors):Do you want to cover owners and officers under this policy?* Yes No How many owners and/or officers do you want to cover?*Do you want to cover volunteers under this policy?* Yes No How many volunteers do you want to cover?*Do you want to cover any independent contractors under this policy?* Yes No How many independent contractors do you want to cover?*Will countersignature of checks be required?* Yes No Who will be countersigning the checks?* How often will a complete audit be made of your business?* When was the last audit made of your business?* Who was the audit performed by?* Certified Public Accountant (CPA) Independent Accountant Internal N/A Are bank accounts reconciled by someone not authorized to deposit or withdraw therefrom?* Yes No How many employees does your business have?*What service does your business provide?*What type of bond would you like? 1-Year Bond 3-Year Bond (Reduced Rate of 2.85 x Annual Premium) Were you referred to us by Arthur J. Gallagher & Co.?* Yes No Any person who knowingly provides false or misleading information to an insurer for the purpose of obtaining an insurance policy/bond or receiving payment on a claim is committing a crime. Penalties will be enforced in accordance with state law.* I agree.Anything else we need to know?Please upload any documents you have for us. Drop files here or Select files Max. file size: 256 MB, Max. files: 6.
