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Pension Trust ERISA Application

South Coast Surety ERISA Pension Trust Surety BondsERISA Pension trust Surety Bonds ApplicationWeb Application 
 
 Pension Trust / ERISA Bond

 ERISA Bonds in excess of $100,000 require a  signed application

 


Plan Name:
Plan Type:
Amount of Plan:
Bond Amount Requested (ERISA Requires 10% of Plan Amount):
Effective Date of Bond:
Contact Name:
Business Address:
Business Phone:
Business Fax:
Email address:
Are regular outside audits conducted on the plan?:
 Yes
 No
How Often?:
By Whom?:
Number of Plan Trustees/Fiduciaries:
Previous Surety?:
Why Change?:
Are any plan assets considered non-qualified?:
 Yes
 No
If yes, amount non-qualified:
Any Dishonesty losses in past five years:
 Yes
 No
Referred by:
Referred by (other):
Comments:
By Submitting this application you are certifying that all provided information is accurate.
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No Credit Cards will be processed until
AFTER THE RATE CONFIRMATION HAS BEEN PROVIDED.

Premiums for On-Line Applications
are fully earned upon approval and payment.

                                            Fraud Statement
 “Any Person who knowingly and with intent to injure, defraud, or deceive and insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony in the third degree.”

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