BOND/GUARANTEE PROPOSAL/KYC FORM

IMPORTANT

An Insurance Agent who assists an applicant to complete an application or proposal form for insurance shall be deemed to have done so as the agent of the applicant – Section 54 (2) Insurance Act 2003.Please answer ALL questions in full. Use CAPITAL LETTERS.

DETAILS OF THE PARTY TO BE GUARANTEED (Party to be protected by the insurance policy)

Name of Proposer:

Address of Proposer (Not P.O. Box):

Company Website:

Email Address:

Telephone Number:

Telephone 2:

Business Location:

Name of Principal Directors:

(1)
(2)
(3)

CONTRACT DETAILS

Name of Employer:

Address of Employer:

Has Proposer Defaulted in any Previous Contract? Yes No

Give Details:

Details of Work to be Done:

Contract Location:

Contract Price:

Contract Period:

Type of Bond Required:
Advance Payment Bond
Performance Bond
Counter Guaranty Bond
Security Guaranty Bond
Custom Bond
Bid Bond
Credit Bond
other