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Probate Bond Application

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If this application is part of a campaign, enter the name below:
What type of probate bond do you need?*
What state do you need the bond for?*
What bond amount do you need?*
What is your full name?*
What is your address?*
Street Address City State ZIP Code
What county do you live in?*
What is your email address?*
Enter Email Confirm Email
Were you referred to us by Arthur J. Gallagher & Co. (AJG)?*
- Yes
- No
Were you referred to us by a broker?*
- Yes
- No
What is the name of the broker that referred you to us?*

What is the case number?*
If Veteran Affairs Bond, please enter VA file number.
What is the court name?*
If Veteran Affairs Bond, please enter the "reply refer to" from the letter you received from the VA.
What is your phone number?*
What is your Social Security Number?*

You're on a secure network. We need your SS# to pull credit. This is a soft pull that does not adversely affect your credit score.
What is your date of birth?*
MM slash DD slash YYYY
What is the name of your employer?*
What is your position with your employer?*
How long have you worked for your employer?*
What is your annual income?*
Are you married?*
- Yes
- No
What is your spouse's full name?*
What is your spouse's Social Security Number?*

You're on a secure network. We need your spouse's SS# to pull credit. This is a soft pull that does not adversely affect your spouse's credit score.

What is the name of your decedent/ward?*
What is the ward's date of birth?*
MM slash DD slash YYYY
What is the Ward's age?*
What is your relationship to the decedent/ward?*
What is the ward's condition?*
Please choose from the following: "Minor" "Deceased" or "Incapacitated".
Please enter the date of death?*
MM slash DD slash YYYY
Please enter the date of appointment.*
MM slash DD slash YYYY
Please list names of heirs or beneficiaries of ward or decedent.*
Are there any disputes among the heirs?*
- Yes
- No
Please explain the disputes.*
Please list amount of estate cash.
Please list amount of securities.
Please list amount of real property.
Please list amount of other assets.
Please list amount of annual income.
All previous sources combined.
Are any of the assets restricted?*
If so, please list them.
Does the estate contain an ongoing business?*
If so, please list businesses.
Are you indebted to the decedent/person you are caring for?*
- Yes
- No
Please explain how you are indebted to the decedent/person you are caring for.*
Include the amount you are indebted for.
Do you have an attorney?*
- Yes
- No

What is the name of your attorney's law firm?*
We are unable to issue your bond without an attorney representing you.
What is your attorney's name?*
What is your attorney's address?*
Please include city, state and zip code.
What is your attorney's email address?*
Enter Email Confirm Email
What is your attorney's phone number?*

I understand that the first year’s bond premium is not refundable.*
- I accept
I understand that all increases and reduction of the bond must be ordered by the court.*
- I accept
I understand that the bond is in effect until a final discharge is signed by the judge and a copy delivered to the surety.*
- I accept
I understand that the bond premium is to be paid annually.*
- I accept
I understand that I must retain an attorney throughout the administration of this estate.*
- I accept
All information furnished on this application will be utilized and relied upon in the issuance of any bond, on or after the listed date. By submitting this application, you acknowledge and authorize the procurement and use of a credit report for the individuals and/or business listed in this application. If submitted by a third party, you acknowledge and agree that you have the authorization of the applicant.*
I accept
Have you or your spouse had a criminal conviction, bankruptcy, or lost a civil judgment? If yes, please explain the criminal conviction, bankruptcy, and/or lost civil judgment.*
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Contact Surety Solutions, A Gallagher Company

Email: customercare@suretysolutions.com

4285 Commercial Street SE
Suite 110
Salem, OR 97302

(866) 722-9239

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