Form L-2080 - State Motor Fuel User Fee Bond Page 3
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3South Carolina Motor Fuel Bond
Form L-2080 Instructions
All information and signatures are required for the bond to be accepted.
Completed bond should be attached to the motor fuel license application or attached to the letter
requesting the replacement bond.
Definition of Bond Participants
Principal - Means the company applying for the motor fuel license.
Surety - Means the bonding or insurance company taking responsibility for the bond.
Page 1 (front page)
General Information
Provide the name and address of the company/individual applying for the motor fuel license.
Provide the name of the bonding or insurance company responsible for the bond.
Provide the amount of the bond both as written amount and a numerical amount.
Provide the date and the name of the company/individual applying for the motor fuel license.
Provide the name of the bonding or insurance company, the address of the home office and/or the surety's South Carolina
agent's location (if applicable).
Page 2 (back page)
Provide South Carolina County for notary. If not located in South Carolina, you should strike through and enter correct
state and county. All witnesses must be different individuals and should not be the same as the person representing the
principal.
Witness as to Principal
Provide printed name of person acting as witness number one (1).
Provide name of company/individual applying for the motor fuel license.
Provide name of person authorized to represent the company/individual for the purpose of executing the bond.
This should not be the same person as the witnesses.
Provide printed name of person acting as witness number two (2)
Provide Notary Information
Provide signature of person acting as witness number one (1)
1. Signature of witness number one
2. Signature of witness number two
Print name of company/individual applying for the motor fuel license.
Provide signature of person authorized to represent the company/individual for the purpose of executing the bond as listed
above. This should not be the same person as the witness.
Witness as to Surety
Provide printed name of person acting as witness number three (3).
Provide name of bonding or insurance company responsible for the bond.
Provide name of person authorized to represent the bonding or insurance company for the purpose of executing the bond.
This should not be same person as the witnesses.
A power of attorney must be attached to bond which reflects this person's name.
Provide printed name of person acting as witness number four (4)
Provide Notary Information
Provide signature of person acting as witness number three (3)
3. Signature of witness number three
4. Signature of witness number four
Provide name of bonding or insurance company responsible for the bond.
Provide signature of person authorized to represent the bonding or insurance company for the purpose of executing the
bond as listed above. A power of attorney must be attached to bond which reflects this person's name.
If you have any questions or need assistance completing this form, call the Motor Fuel Section at (803) 896-1990.
41623026
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