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TERMS AND CONDITIONS

TERMS AND CONDITIONS

1. I understand false statements may result in forfeiture of benefits and possible prosecution by the US Attorney-General Any person who knowingly and with the intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing false, or misleading information is guilty of a felony

2. The above is only a conditional offer and is subject to change or rescission based upon a multitude of considerations.

3. The above quoted may include a broker fee. Therefore, the undersigned hereby agrees that if a fee is charged, to pay the fee in the amount.

4. If the Bond is canceled the commission shall also be considered a fee, and fully earned.

5.  WorldWide Insurance Specialists, Inc. may also be acting on behalf of the insurer issuing the subject Bond(s) or insurance and will be receiving a commission.  This agreement shall serve as the writing required pursuant to the rules set forth by your Department of Insurance (Broker/Agents shall comply with their applicable state regulations regarding fees).Fees include premium, processing, state tax, surplus tax, brokers and commission fee where applicable

6. COMPLETION OF THIS FORM CONSTITUTES PERMISSION FOR WORLDWIDE INSURANCE SPECIALISTS INC. TO OBTAIN CONSUMER INFORMATION WHICH WILL BE USED TO DETERMINE BONDING ELIGIBILITY. THIS INFORMATION WILL BE HELD IN THE STRICTEST CONFIDENCE

BY CLICKING I ACCEPT YOU ARE ACCEPTING THE TERMS AND CONDTIONS

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