New York Automobile Broker Bond Application

Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false, incomplete, or misleading information, or conceals information concerning any material fact whereto, commits a fraudulent insurance act, which is a crime punishable by incarceration, and shall also be subject to civil penalties.

CONTACT INFORMATION

APPLICANT INFORMATION

Has the business or any of the owners involved;

PERSONAL INFORMATION — Owner #1

PERSONAL INFORMATION — Owner #2 (if applicable)

PERSONAL INFORMATION — Owner #3 (if applicable)

PERSONAL INFORMATION — Owner #4 (if applicable)

PERSONAL INFORMATION — Owner #5 (if applicable)

Bond Form Upload

If the party requiring the bond gave you paperwork that included a specific bond form, please upload that form here. This will help streamline the process and get you the bond you need! Please Note: Multiple Files must all be uploaded at once.

TERMS OF SERVICE

Completion of this online application constitutes permission for World Wide Agent Services, Inc. and its selected surety companies to obtain consumer information, including personal credit reports of individual applicants as well as owners and officers of business applicants, which may be used to determine bonding eligibility. Such credit reports may also be obtained at the time of any review or renewal, any potential or actual claim, or for any other legitimate purposes as determined by the surety companies in their reasonable discretion. This information is held in strict confidence.