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Welcome FOP

We are here to assist you with placement of your Fiduciary Bond needs for your lodge, and any other insurance needs for your lodge. Please complete the following bond form and submit securely to our office. Please contact us directly with any additional questions or for assistance.

LIMIT / ANNUAL PREMIUM
$10,000 / $100 /yr
$25,000 / $125/yr
$50,000 / $250/yr
$100,000 / $500/yr
$200,000 / $1000/yr
$300,000 / $1500/yr

Application For Bond

Pekin Insurance Company Application For Bond

Applicant's Full Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Amount of Bond*
Type of Bond*
Previously Bonded By*
Position/Official Title Of Applicant
Has Applicant Occupied This Office/Position Before?
- Yes
- No
If Yes, When Was Position Occupied?
Will Applicant Sign Checks?
- Yes
- No
Is Countersignature Required?
- Yes
- No
Name Who Needs To Countersign
First Last
Who Receives And Reconciles the Monthly Bank Statements?
Who Makes The Bank Deposits?
Do You Have Custody Of Securities?
- Yes
- No
Are The Securities Subject To Joint Control?
- Yes
- No
Name Of Security Joint Control Individual
First Last
How Frequently Are Audits Made?
Audits Are Made By Whom?
When Was Last Audit Made?
MM slash DD slash YYYY
Period Covered
Was Applicant Appointed or Elected To This Office?
- Appointed
- Elected
Term Of Office
- Indefinite
Term Beginning
Term Ending
Do You Employ Deputies?
- Yes
- No
Will You Require Bonds From Your Deputies?
- Yes
- No
What Amounts For Bonds?
If You Recieve Public Funds For Deposit, Have You Obtained Designation Of Depositories?
- Yes
- No
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