Form DOL-13 "Employer's Statutory Surety Bond for Reimbursement in Lieu of Contributions" - Georgia (United States)

What Is Form DOL-13?

This is a legal form that was released by the Georgia Department of Labor - a government authority operating within Georgia (United States). As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2014;
  • The latest edition provided by the Georgia Department of Labor;
  • 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 printable version of Form DOL-13 by clicking the link below or browse more documents and templates provided by the Georgia Department of Labor.

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Download Form DOL-13 "Employer's Statutory Surety Bond for Reimbursement in Lieu of Contributions" - Georgia (United States)

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STATE OF GEORGIA - DEPARTMENT OF LABOR
148 Andrew Young International Blvd., N.E., Suite 850
Atlanta, Georgia 30303-1751
Phone: (404) 232-3301
EMPLOYER’S STATUTORY SURETY BOND
FOR REIMBURSEMENT IN LIEU OF CONTRIBUTIONS
Georgia DOL Account No.
Calendar Years
Surety Bond No.
STATE OF GEORGIA
COUNTY
KNOW ALL MEN BY THESE PRESENTS, That,
an employer subject to the provisions of OCGA Sections 34-8-33, 34-8-34, 34-8-158, 34-8-159 and 34-8-160 of the
Employment Security Law, and having its principal place of business at
,
as principal, and
,
a surety corporation authorized by law to transact business in the State of Georgia, as surety, pursuant to the aforesaid
law and in compliance therewith, are hereby held and firmly bound unto the Commissioner of Labor of the State of
Georgia, and his successors in office, and unto the State of Georgia, Department of Labor, upon the conditions,
hereinafter set forth, in the full sum of
($
), for the payment of which well and truly to be made we bind ourselves, our heirs, administrators,
executors, successors and assigns jointly and severally, firmly by these presents.
Signed, sealed and delivered this
day of
, 20
THE CONDITIONS OF THE FOREGOING OBLIGATION are such that the above named principal has been
duly registered as an employer under the Employment Security Law subject to the provisions of the said Employment
Security Law;
NOW THEREFORE, should the said principal well and truly file all reports and otherwise timely fulfill and
comply with all requirements and regulations set forth in said Employment Security Law and pay all payments in lieu of
contributions due and to become due under said law, and penalties and interest assessed pursuant to said law for the
period
to
then this obligation to be void, otherwise, of full force and effect.
IN WITNESS WHEREOF, the said principal and surety have executed this instrument under their hands and
seals, including the corporate seals, this
day of
, 20
Witnesses:
(L.S.)
(Principal)
(L.S.)
Attest:
By
APPROVED AS TO AMOUNT, FORM AND
SURETY BY:
Countersigned by:
UI Legal
GEORGIA DEPARTMENT OF LABOR
NOTE: The official or attorney in fact signing for Surety shall attach to the original bond a certified copy of authority or
power to bind the Surety. It shall show that the power is in force and effect at the time of the execution of the bond.
DOL-13 (R-4/14)
STATE OF GEORGIA - DEPARTMENT OF LABOR
148 Andrew Young International Blvd., N.E., Suite 850
Atlanta, Georgia 30303-1751
Phone: (404) 232-3301
EMPLOYER’S STATUTORY SURETY BOND
FOR REIMBURSEMENT IN LIEU OF CONTRIBUTIONS
Georgia DOL Account No.
Calendar Years
Surety Bond No.
STATE OF GEORGIA
COUNTY
KNOW ALL MEN BY THESE PRESENTS, That,
an employer subject to the provisions of OCGA Sections 34-8-33, 34-8-34, 34-8-158, 34-8-159 and 34-8-160 of the
Employment Security Law, and having its principal place of business at
,
as principal, and
,
a surety corporation authorized by law to transact business in the State of Georgia, as surety, pursuant to the aforesaid
law and in compliance therewith, are hereby held and firmly bound unto the Commissioner of Labor of the State of
Georgia, and his successors in office, and unto the State of Georgia, Department of Labor, upon the conditions,
hereinafter set forth, in the full sum of
($
), for the payment of which well and truly to be made we bind ourselves, our heirs, administrators,
executors, successors and assigns jointly and severally, firmly by these presents.
Signed, sealed and delivered this
day of
, 20
THE CONDITIONS OF THE FOREGOING OBLIGATION are such that the above named principal has been
duly registered as an employer under the Employment Security Law subject to the provisions of the said Employment
Security Law;
NOW THEREFORE, should the said principal well and truly file all reports and otherwise timely fulfill and
comply with all requirements and regulations set forth in said Employment Security Law and pay all payments in lieu of
contributions due and to become due under said law, and penalties and interest assessed pursuant to said law for the
period
to
then this obligation to be void, otherwise, of full force and effect.
IN WITNESS WHEREOF, the said principal and surety have executed this instrument under their hands and
seals, including the corporate seals, this
day of
, 20
Witnesses:
(L.S.)
(Principal)
(L.S.)
Attest:
By
APPROVED AS TO AMOUNT, FORM AND
SURETY BY:
Countersigned by:
UI Legal
GEORGIA DEPARTMENT OF LABOR
NOTE: The official or attorney in fact signing for Surety shall attach to the original bond a certified copy of authority or
power to bind the Surety. It shall show that the power is in force and effect at the time of the execution of the bond.
DOL-13 (R-4/14)