Form Bishca 2/2012 Ia - Vermont Surety Bond Form printable pdf download

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

Form Bishca 2/2012 Ia - Vermont Surety Bond Form