Form L-106 - Bond Of Managing General Agent

ADVERTISEMENT

INSURANCE LICENSING SECTION
2910 NORTH 44TH STREET, SUITE 210
PHOENIX, ARIZONA 85018-7256
BOND NUMBER: ____________________
BOND OF MANAGING GENERAL AGENT (FORM L-106)
I/We, __________________________________________________________, as Principal for an
Arizona Insurance Managing General Agent license and _______________________________________,
as an admitted surety insurer (“Surety”), bind ourselves to the penal sum of _________________________
for the benefit and protection of insureds and insurers whose monies the managing general agent handles.
This obligation in conditioned upon the Principal being granted a Managing General Agent license
from the Arizona Department of Insurance.
This bond shall remain in force until released by the Director of Insurance or until canceled by the
Surety. Without prejudice to any liability previously incurred thereunder, the Surety may cancel the bond
upon thirty (30) days advanced written notice filed with the Director of Insurance.
Dated this _______ day of ____________________,
__________________________________________
Full Signature of Principal (Broker)
(including FULL first, middle and last names)
__________________________________________
Full Name of Surety Insurer
By:
__________________________________________
Attorney-in-fact
Countersigned at:
(Affix Surety
________________________________ (City/State)
company seal)
_______________________________________
Signature of Surety’s Agent
(Other Than Principal)
Any surety company duly authorized to transact insurance business in the State of Arizona may become
Surety on this bond.
This bond must be countersigned by a licensed resident Arizona agent of the surety company. A power of
attorney must be attached to this bond. This bond must be signed by the Principal and the Surety’s
attorney-in-fact.
Form L-106 (eff. 03/99)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go