Special Needs Trustee Court Bond Application Form

CONTACT INFORMATION

Contact Name (If insurance agent, please include Agency Name) *

Email *

Phone Number *

Fax Number

APPLICANT INFORMATION

Applicant Name (Exactly as to appear on Bond) *

What is the applicant's experience in handling fiduciary responsibilities? *

Social Security Number *

Date of Birth *

*

Married

Single

Residence Address *

Country

City

State

Zip code

Business Address *

Country

City

State

Zip code

Occupation or Business *

How Long So Engaged? *

Previous Surety *

Yes

No

Type of Bond *

Bond Amount *

Effective Date *

Obligee (Who is requiring you to have the bond) *

Obligee Address *

Country

City

State

Zip code

Name of Deceased (Ward) *

Date of Death *

Date of appointment (If over 6 months, please explain delay) *

Is applicant indebted to the estate or trust? *

Yes

No

Has applicant had prior possession of estate assets (i.e. Power of Attorney, Bank Accounts, etc.)? *

Yes

No

Name of Attorney *

Attorney Address *

Country

City

State

Zip code

Attorney Telephone # *

Will the attorney remain involved throughout the duration of the estate? *

Yes

No

Assets of estate or trust (describe) *

LIST APPLICABLE STATUSES OF FOLLOWING INDIVIDUALS BELOW

Minors

Name

Age

Health Status

Incompetent

Name

Age

Health Status

Applicant's Relationship to *

deseased

ward(s)

*

Applicant's Net Worth *

Are guardianship funds to be used for support of ward? *

Yes

No

Approximately how much per month? *

What is the source of the guardianship funds? *

LIST HEIRS BELOW

Heir #1 *

Relationship *

% of estate *

Heir #2

Relationship

% of estate

Has anyone objected to the applicant's appointment as fiduciary? *

Yes

No

Is this bond required on the demand of an interested person? *

Yes

No

COURT INFORMATION

Name of Court *

Address of Court *

Country

City

State

Zip code

Please attach copy of court order paperwork *

It is required you upload court documents and signed General Indemnity Agreement. General Indemnity Agreement can be downloaded by clicking HERE
Please Note: When uploading multiple files, all files must be added 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.

*

I acknowledge that I have read and agree to the above Terms of Service on the following date:

*