ACCREDITED SURETY AND CASULATY COMPANY,INC.
CONFIDENTAIL INDEMNITY APPLICATION AND INDEMNITY FOR BAIL BOND

I, the undersigned, do hereby apply to the ACCREDITED SURETY AND CASUALTY COMPANY, INC., to act as my bail in the amount of:

$ in the court(s) of

wherein I am charged with .
TERMS AND CONDITIONS

The following terms and conditions are an integral part of this application for appearance

BOND(S) # for which ACCERDITED SURETY AND CASUALTY COMPANY, INC., (hereinafter called SURETY),

or its Agent shall receive a premium in the amount of dollars,
and the parties agree that said appearance bond(s) is conditioned upon full compliance by the principal of all said terms and condition and is a part of said bonds and applications therefore.
1. The SURETY, as bail, shall have control and jurisdiction over the principal during the term for which the bond is executed and shall have the right to apprehend, arrest, and surrender the principal to the proper officials at any time as provided by law.
2. In the event surrender of principal is made prior to the time set for principal's appearances, and for reason other than as enumerated below in paragraph 3, the principal shall be entitled to a refund of the bond premium.
3. It is understood and agreed that the happening of any one of the following events shall constitute a breach of principal's obligations to the SURETY hereunder, and the SURETY shall have the right to forthwith apprehend, arrest and surrender principal, and principal shall have no right to any refund of premium whatsoever. Said events which shall constitute a breach of principal's obligations hereunder are:
(a) If principal shall depart the jurisdiction of the court without written consent of the court and the SURETY or its Agent.
(b) If principal shall move from one address to another within the state of Florida without notifying the SURETY or its agent in writing prior to said move.
(c) If principal shall commit any act which shall constitute reasonable evidence of the principal's intention to cause a forfeiture of said bond.
(d) If principal is arrested and incarcerated for any other offense other than a minor traffic violation.
(e) If principal shall make any material false statement in this application.
(f) Violation of any other condition or criteria ordered by the Court including, but not limited to electronic monitoring and/or drug testing.

First Name: Middle Name: Last Name: Nickname/Street Name:

HAVE YOU EVER BEEN ARRESTED UNDER ANY OTHER ALIAS? YES NO If Yes, What Alias?

Current Address (Street, Apt., or Suite):
City: State: Zip Code: How Long:
Own Home Rent Home
Rent from whom: Name of Apartment/Condo:
Previous Address (If less than 5 years):
City: State: Zip Code:
Email Address:
Home Phone: Cell Phone:
Sex: Race: Height: Weight: Eyes: Hair:
Tattoos/Scars/Marks:
D.O.B. Birthplace:
Drivers License No. State Issued:
S.S.#:
Previous Arrests:
Bond Before By:

ARE YOU ON PROBATION OR PAROLE? NO YES
If Yes, Felony Misdemeanor
Name of Supervising Officer: Supervising Officer's Telephone:
What is your relationship with the Indemnitor?
How Long have you know the Indemnitor?
U.S. Citizen YES NO If not, what country do you hold citizenship?
LEGAL RESIDENT ALIEN YES NO
Resident Alien Registration Number: Other-Visiting From:
Current Employer:
Occupation: How Long?
Employer Address:
City: State: Zip Code: Phone:
If Unemployed, are you Retired Disabled
Other: If others, who pays your bills?
Previous Employer:
Address: How Long? Phone:
Previous Employer:
Address: How Long? Phone:
SPOUSE INFORMATION

Wife Girlfriend Husband Boyfriend Friend

Spouse's Name: S.S. #

Current Address (Street, Apt., or Suite):
City: State: Zip Code: Phone:
Employer:
Employer Address:
City: State: Zip Code: Phone:
Child's Name: Age: School:
Child's Name: Age: School:
AUTO
Year: Make: Model: Color:
Tag Number: State: Where Fiance:
Amount Owed:
Father: Phone: Address:
Mother: Phone: Address:
Brother: Phone: Address:
Sister: Phone: Address:
Reference: Phone: Address:
Attorney: Phone: Address:

I hereby fully authorize Accredited Surety and Casualty Company, Inc. to conduct any background investigation including credit check on me at all times. For good and valuable consideration the undersigned principal hereby agrees to indemnity and/or hold harmless, the Accredited Surety and Casualty Company, Inc. or its Agent for any and all losses not otherwise prohibited by law, or rules and regulations promulgated under any applicable statute. Signed, sealed and delivered this

day of , 20 .


Applicant's Signature
ACCREDITED SURETY AND CASULATY COMPANY,INC.
CONFIDENTAIL INDEMNITY APPLICATION
First Name: Middle Name: Last Name:
Nickname/Street Name:
Current Address (Street, Apt., or Suite):
City: State: Zip Code: How Long:
Own Home Rent Home
Rent from whom: Name of Apartment/Condo:
Previous Address (If less than 5 years):
City: State: Zip Code:
Email Address:
Home Phone: Cell Phone:
Sex: Race: Height: Weight: Eyes: Hair:
D.O.B. Birthplace:
Drivers License No. State Issued:
S.S.#:
What is the relationship to the Defendant?
How Long have you known the Defendant?
U.S. CITIZEN YES NO If not, what country do you hold citizenship?
LEGAL RESIDENT ALIEN YES NO
Resident Alien Registration Number: Other-Visiting From:
Current Employer:
Occupation: How Long?
Employer Address:
City: State: Zip Code: Phone:
If Unemployed, are you Retired Disabled
Other: If others, who pays your bills?
Previous Employer:
Address: How Long? Phone:
INDEMNITOR INFORMATION:
S.S.# Wife Girlfriend Husband Boyfriend Friend
Indemnitor Name:
Address:
City: State: Zip Code:
Cell Phone: Home Phone:
Indemnitor's Current Employer:
Employer Address: City: State: Zip:
Child's Name: Age: School:
Child's Name: Age: School:
AUTO
Year: Make: Model: Color:
Tag Number: State: Where Fiance:
Amount Owed:
HAVE YOU EVER FILED BANKRUPTCY? YES NO If Yes When?
Where do you bank? S.S # What Branch?
Checking Savings Money Market
Reference: Phone: Address:
PRIMARY CONTACT INFORMATION
WIFE GIRLFRIEND HUSBAND BOYFRIEND FRIEND OTHER
Indemnitor's Name: Address: City: State: Zip Code: Cell Phone:
Indemnitor's Current Employer: Employer's Address: City: State: Zip Code: Employer's Phone:
INDEMITY AGREEMENT

You are assuming specific obligations - READ CAREFULLY!
WHEREAS ACCREDITED SURETY AND CASUALTY COMPANY, INC., a Florida Corporation, (hereafter called the SURETY) at the request of the undersigned, and upon the SURETY thereof, has or is about to become SURETY on an appearance bond for
in the sum of Dollars by its certain bond or undertaking, a copy of which is attached hereto and made part hereof:

NOW THEREFORE, in consideration of the promises and the sum of one dollar hand paid, receipt whereof by each of us is hereby acknowledge, the undersigned hereby do undertake, agree and bind themselves, their legal representatives, successors and assigns, as follows:

1. That the undersigned will have the aforesaid forthcoming before the above court named in said bond attached hereto, at the time therein fixed, from day to day and term to term thereafter, as may be ordered by the said court.
2. That the undersigned will at all times indemnify, defend and save the SURETY harmless from and against every and all claim, demand, liability, cost charge, counsel fee, expense (investigation costs at $ per hour per bail agent/private investigator), mileage, travel expenses, attorneys fees and court costs for collection and enforcement of this agreement, suit, order, judgment or adjudication whatsoever which the SURETY shall or may for any cause at any time sustain or incur, by reason or inconsequence of the SURETY having executed said bond or undertaking, will, upon demand, pay the SURETY all funds to meet every claim, demand, liability, cost charge, counsel fee, expense, suit, order, judgment or adjudication against it, by reason of such Suretyship, and before it shall be required to pay the same.
3. That in the event of litigation of this Indemnity Agreement, venue shall be in (County) (State) .
4. I hereby fully authorize Accredited Surety and Casualty Company, Inc to conduct any background credit check on me at all times.
5. The condition of this Indemnity Agreement provides that as long as there is any liability or loss of any nature whatsoever to the SURETY upon the bond referred to herein, the undersigned will not make any transfer, or any attempted transfer of any property, real or personal, given as security or which the undersigned may subsequently acquire or any interest therein, and it is further agreed that the SURETY shall have a lien upon all property or the undersigned for any sums due it or for which it has become, or may become, liable by reason of its having executed the bond referred to herein.
6. That the voucher or other evidence of any payment may be made by the SURETY, by reason of such Suretyship, shall be conclusive evidence of such payment against the undersigned and the undersigned's estate both to the propriety thereof and as to the extent of the liability thereof to the SURETY.
7. That the SURETY may withdraw from its Suretyship upon said bond or undertaking at any time that it may see fit, as provided by law.
8. That the Indemnity Agreement shall not be returned by the SURETY at the time it shall be satisfied of the termination of its liability under said bond or obligation, but shall be retained as security for any liability that may at any time thereafter occur.
9. That the failure of any of the undersigned to comply with the provisions of this Indemnity Agreement shall be binding upon the others.
10. If any provision or provisions of this Indemnity Agreement be void or unenforceable under the laws of any place governing its construction or enforcement, this Indemnity Agreement shall not be void or vitiated thereby bust shall be construed and enforced with the same effect as though such provisions were omitted.

IN WITNESS THEREOF, the undersigned have duly executed this Indemnity Agreement day of , 20
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE DEFRAUD OR DECEIVE ANY INSURER FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE INCOMPLTE OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE.

Witness

Indemnitor Signature (seal)

 

STATE OF COUNTY OF

On this day of , before me personally

appeared , to me know to be the person described in and who executed the foregoing Indemnity Agreement and He/She/They thereupon acknowledged to me that He/She/They executed the same.

 

 


Notary