Form Fis 2137 - Bond - Mortgage Loan Originator - Company - Michigan Department Of Insurance And Financial Services Page 3

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FIS 2137 (10/16) Department of Insurance and Financial Services Page 2 of 2

Bond No.

__________________

Sponsoring Company NMLS ID No. __________________

Bond - Mortgage Loan Originator - Company

Complete this form with original signatures.

Sealed with our seals, and dated this _______ day of ________________________, 20___.

In the presence of

Witness Signature

Surety Signature

Witness name, typed or printed

Surety name, typed or printed

Witness Signature

Principal Signature

Witness name, typed or printed

Principal name, typed or printed

Authorized under Act No. 75 of the Public Acts of 2009, as amended. Required for Mortgage Loan Originator applicants and licensees. Failure to properly file may result in denial or revocation of your license or

application for licensure