VERMONT SURETY BOND FORM
STATE OF VERMONT
DEPARTMENT OF BANKING, INSURANCE, SECURITIES AND HEALTH CARE
ADMINISTRATION
89 Main Street
Montpelier, Vermont 05620-3101
Bond No. ____________________
KNOW ALL PERSONS BY THESE PRESENTS:
That,
________________________________________________________________________________as
Name and address of Investment Advisor
Principal, having filed with the office of the Vermont Department of Banking, Insurance, Securities and
Health Care Administration on or about the ___________ day of ____________, __________, an
application to transact business in Vermont as an investment advisor and
___________________________________________________________________________________
Name and address of surety
as Surety, a corporation organized under the laws of the State of ________________ and being duly
authorized to transact the business of indemnity and suretyship in Vermont, do hereby acknowledge our
indebtedness to the State of Vermont, for the use and benefit of the State of Vermont and any person(s)
having a claim under the conditions of this obligation, in the sum of
_____________________________________________________________Dollars ($______________),
as required by Section 5411 of Title 9, V.S.A, Chapter 150 (“Vermont Securities Act” ), provided,
however, that the aggregate liability hereunder shall not exceed the sum of
_____________________________________Dollars, ($__________) regardless of the number of
claimants, and shall not be construed as individual liability.
The effective date of this Bond is ________________________, _____________.
LIABILITY for the payment of this sum, to which we hereby obligate and bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally, becomes effective upon the
following conditions:
1. Registration of the Principal to transact business in Vermont as an investment advisor
2. Failure by the Principal and/or its agents to strictly comply with all applicable provisions of,
and orders, rules and regulations issued pursuant to the Vermont Securities Act.
3. The Surety shall notify the Commissioner within five business days of receipt by the Surety
of any claim under this bond or upon the making of any payment under this bond.
This Bond may be canceled by the Surety upon 30 days written notice by registered mail to the Principal
and to the Department of Banking, Insurance, Securities and Health Care Administration in which case
this Bond shall be considered canceled upon the expiration of said 30 day period except as to liability for
acts or omissions which occur prior to the date of cancellation. Notice shall be deemed effective upon
BISHCA 2/2012 IA