Form AID-LI-SLB "Surplus Lines Insurance Broker/Producer Bond" - Arkansas

What Is Form AID-LI-SLB?

This is a legal form that was released by the Arkansas Insurance Department - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2016;
  • The latest edition provided by the Arkansas Insurance Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AID-LI-SLB by clicking the link below or browse more documents and templates provided by the Arkansas Insurance Department.

ADVERTISEMENT
ADVERTISEMENT

Download Form AID-LI-SLB "Surplus Lines Insurance Broker/Producer Bond" - Arkansas

Download PDF

Fill PDF online

Rate (4.6 / 5) 54 votes
FORM AID-LI-SLBB (2/16)
ARKANSAS INSURANCE DEPARTMENT
LICENSE DIVISION
RD
1200 WEST 3
STREET
LITTLE ROCK, AR 72201
PHONE: 501-371-2750
FAX: 501-683-2604
Surplus Lines Insurance Broker/Producer Bond
KNOW ALL MEN BY THESE PRESENTS:
That we, ________________________________________ of ____________________, Arkansas, as Principal, and
________________________________________________of _________________________________, as Surety
are held and firmly bound unto the State of Arkansas, in the full and just sum of FIFTY THOUSAND DOLLARS
($50,000) lawful money of the United States for payment of which sum, well and truly to be made, we hereby bind
ourselves, our and each of our heirs, executors and administrators, successors and assigns, jointly and severally,
firmly by these presents.
Sealed with our seals, and dated the ______ day of ________________________, 20__.
THE CONDITION OF THIS OBLIGATION IS SUCH THAT:
WHEREAS, the above bounden Principal has taken all necessary legal steps as required by the Insurance
Commissioner of the State of Arkansas to qualify as a Surplus Lines Broker and doing and performing such other
acts as may be necessary to comply with all requirements of the Arkansas Insurance Code, as amended.
NOW THEREFORE, the condition of this obligation is such that if the above bounden Principal shall well and
truly comply with the laws of the State of Arkansas pertaining to Surplus Lines Insurance Broker, then this
obligation shall be null and void; otherwise to remain in full force and effect.
PROVIDED, this Bond may be cancelled by the Surety by filing thirty (30) days written cancellation notice by
registered mail with the Insurance Commissioner, State of Arkansas, Little Rock, Arkansas.
IN WITNESS WHEREOF, the Principal has hereunto set his hand and the Surety has caused its corporate
name to be hereunto signed, and its corporate seal attached by its duly authorized Attorney-in-fact the day and year
first above written.
_______________________________
Principal
BY _____________________________
Title
______________________________
Surety
BY_____________________________
Attorney-in-fact
Countersigned:
FORM AID-LI-SLBB (2/16)
ARKANSAS INSURANCE DEPARTMENT
LICENSE DIVISION
RD
1200 WEST 3
STREET
LITTLE ROCK, AR 72201
PHONE: 501-371-2750
FAX: 501-683-2604
Surplus Lines Insurance Broker/Producer Bond
KNOW ALL MEN BY THESE PRESENTS:
That we, ________________________________________ of ____________________, Arkansas, as Principal, and
________________________________________________of _________________________________, as Surety
are held and firmly bound unto the State of Arkansas, in the full and just sum of FIFTY THOUSAND DOLLARS
($50,000) lawful money of the United States for payment of which sum, well and truly to be made, we hereby bind
ourselves, our and each of our heirs, executors and administrators, successors and assigns, jointly and severally,
firmly by these presents.
Sealed with our seals, and dated the ______ day of ________________________, 20__.
THE CONDITION OF THIS OBLIGATION IS SUCH THAT:
WHEREAS, the above bounden Principal has taken all necessary legal steps as required by the Insurance
Commissioner of the State of Arkansas to qualify as a Surplus Lines Broker and doing and performing such other
acts as may be necessary to comply with all requirements of the Arkansas Insurance Code, as amended.
NOW THEREFORE, the condition of this obligation is such that if the above bounden Principal shall well and
truly comply with the laws of the State of Arkansas pertaining to Surplus Lines Insurance Broker, then this
obligation shall be null and void; otherwise to remain in full force and effect.
PROVIDED, this Bond may be cancelled by the Surety by filing thirty (30) days written cancellation notice by
registered mail with the Insurance Commissioner, State of Arkansas, Little Rock, Arkansas.
IN WITNESS WHEREOF, the Principal has hereunto set his hand and the Surety has caused its corporate
name to be hereunto signed, and its corporate seal attached by its duly authorized Attorney-in-fact the day and year
first above written.
_______________________________
Principal
BY _____________________________
Title
______________________________
Surety
BY_____________________________
Attorney-in-fact
Countersigned: