Form Il 567-0015-A - Application For State Of Illinois Distributor/ Importing Distributor/foreign Importer Liquor License Page 10

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You must provide this information to the bank or insurance company that will be providing your bond.
A separate bond is
required for each location. You will not be issued a certificate of registration and cannot be legally registered to do business in
Illinois until we receive your bond. Your bond can be in the form of a
Insurance bonds:
Form REG-4-A, Financial Responsibility Bond, must be completed entirely by your insurance company. Your business, name
and address must be identical to the information you have registered with us. The insurance company issuing your bond must
❒
sign;
❒
stamp their insurance seal;
❒
assign a bond number; and
❒
if applicable, attach their power of attorney stating the attorney-in-fact's name.
All of your business' owners, officers, or partners must sign the bond. If you are a corporation, the president and secretary must
sign the bond. You must also affix your corporate seal. Note: The original bond and power of attorney must be sent to us.
Letter of Credit:
Form REG-4-D, Financial Institution Irrevocable Letter of Credit Bond, must be completed entirely by your bank if you are
providing a bank letter of credit. Your business' name and address must be identical to the information you have registered with
us . The bank issuing your letter of credit must
❒
stamp their bank seal; and
❒
send to us the original bank letter of credit containing the seal.
Note: The Letter of Credit must be signed by an authorized officer of the banking institution.
Certificates of Deposit:
Any bank may issue you a Certificate of Deposit to satisfy your bond requirements. A Certificate of Deposit must
❒
be made payable to the Director, Illinois Department of Revenue;
❒
state that the Certificate of Deposit is automatically renewable;
❒
have a maturity date of 12 months or less; and
❒
have your business' name and identification number ( i.e., Federal Employer's Identification number
(FEIN) or Social Security number).
If you prefer, you can send us a cashier's check and we will purchase the Certificate of Deposit for you.
Note: The original Certificate of Deposit must be sent to us, receipts are not acceptable.
REG-4-A (R-01-04)
IL-492-2364

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