Erisa Bond

First Name:	*
Last Name:	*
Address:	*
Address:	*
City:	*
State:	*
Postal Code:	*
Contact Number:	*
Email Address:	*
3 Year Prepaid:	For bonds larger than $500,000, contact Company.
Is this bond required because more than 5% of the plan assets are "non-qualifying"?	* If yes, please contact our office.
Requested Bond Amount $	*
Effective Date:	*
Legal Name of Plan(s)	*
Type of Business	*
Business Address	*
Mailing Address	*
Total Plan Asset $	*
Number of Trustees	*
Number of Participants	*
	'Coverage provided is commercial blanket fidelity and is limited to trustees of the plan. This bond does not coverindependent Pl?- Administrators.
Is this plan audited by a CPA?	*
Date of Last Audit:	*
If no,why is the plan not audited?	*
Has the applicant experienced any claims in the past five years?	* (If yes, givespecific details on each incident, and any changes made to prevent a reoccurrence,on a separate sheet.)
Previous ERISA coverage?	*
If yes, list the bond carrier	*
	COMPLETE THE FOLLOWING FOR REQUESTS OF $500,000 AND LARGER *
What % of plan assets are employer securities?	%
Are plan accounts reconciled by someone not authorized to I deposit or withdraw funds?	*
Are two (2) or more signatures required for withdrawals and larger checks?	*
Are separate corporate trust account(s) established for the plan assets?	*
If yes,where are the assets held?	*
	The undersigned agrees the above representations are an accurate statement of current information and procedures. This application, with Bond Declarations and Provisions, and endorsements Issued to form a part thereof,constitute the entire contract
* Denotes Required Field - No Credit Check Required - Quick Processing Dimirak Financial PO BOX 2047 Vista, CA 92085-2047 P. 760-806-8200(w) 760-724-7100(f) CA Lic#066068 04-17398 DIMlRAK.COM PENSION TRUST/ERISA BONDS A Bond Designed to Protect Your Valuable Pension Programs What are Pension Trust/ERISA Bonds? Many companies today offer pension plans and/or profit sharing programs as part of a benefit package for their employees . These programs are managed by appointed individuals associated with that company's plan, known as fiduciaries. To protect the plan and the money in these funds from fraud and dishonesty, the appointed fiduciaries need to be bonded. The pension trust bond from Surety Bonding Company of America* does just that. Why Is This Bond Needed? The Pension Reform Act of 1974 (also known as ERISA - Employee Retirement and Income Security Act) states that the funds of pension or profit sharing plans must be protected under a fidelity bond for 10% of the amount of funds handled. As an example , a person who manages a profit sharing program that involves $250,000 in funds must post a bond for $25,000. The Commercial Blanket fidelity bond available from Surety Bonding Company of America* satisfies this requirement at a reasonable cost. Apply For Coverage Now Just complete this application and give it to your Surety Bonding Company of America agent today. Your application will be reviewed the day it is received. 'Bonds are underwritten by Surety Bonding Company of America with Western Surety Company as Co-Surety. SBCA-SURETY BONDING COMPANY OF AMERICA A Subsidiary of CNA Surety Corporation Dimirak Financial Corp. P 0Box 2047 Vista CA 92085-2047