Form Fis 0517 - Alternative Bond In Lieu Of Michigan Based Trust Account

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FIS 0517 (5/15) Department of Insurance and Financial Services Page 1 of 2
Alternative Bond In Lieu of Michigan Based Trust Account
Bond Number: ______________________
That ___________________________________________________________________________________________________
(Name of Firm or Person if Sole Proprietor)
operating as _____________________________________________________________________________________________
(Name of Firm)
________________________________________________________________________________________________________
(State of Corporation, Partnership, Limited Liability Company, or Individual)
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
(List Complete Address of all Offices covered by this Bond)
as Principal and ________________________________________________________________________, a Surety Company
authorized to transact business in Michigan, as surety, are held and firmly bound unto the People of the State of Michigan
in the penal sum of ____________________________________________ lawful money of the United States, to be paid
to the people of the State of Michigan, for which payment will and truly be made, we bind ourselves and our heirs, executors,
administrators, personal representatives, and successors, jointly and severally, firmly by these presents.
WHEREAS, the said___________________________________________________________________________________,
(Name of Firm)
principal obligor herein, is filing herewith an application to the Michigan Department of Insurance and Financial Services for a license
to engage in the business of debt management at the office(s) listed above under the provisions of 1975 PA 148, as amended; and
“If a trust account described in subsection (1) is maintained at a financial institution described in subsection (1) that is located
outside of this state, the licensee shall furnish a surety bond or irrevocable letter of credit for the benefit of the people of the state of
Michigan, in an amount that is equal to or exceeds 100% of the average amount of deposits held in the trust account from month to
month and is in a form approved by the department. This requirement is in addition to an applicant’s obligation under section 5(2)(c).”
NOW, THEREFORE, the condition of this obligation is such that if the said principal obligor herein shall faithfully account for all
monies collected upon accounts entrusted to him and his employees and agents, then this obligation shall be void, otherwise the same
shall be in full force and effect.
PROVIDED, HOWEVER, in no event shall the aggregate liability of the surety under this bond for any and all claims to one or
more claimants exceed the penal sum of this bond.

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