Great Insurance Values.com brought to you by Lakhani Insurance Agency, Inc.

f Great Insurance Values.com brought to you by Lakhani Insurance Agency, Inc.

Lakhani Insurance Agency, Inc.

Individuals, Families & Groups
Life Insurance
Health Insurance
Group Insurance
Dental Insurance
Medicare Supplement
Disability Income
Long-Term Care
Retirement Accounts

Business Owners, Self-Employed
General Liability
Commercial / Business Ins.
Commercial Auto Insurance
Commercial Property
Umbrella Insurance
Employment Practices
Lessor's Risk
Workers Comp

Medical & Dental Professionals
Medical Malpractice

Garage Liability
Auto Dealers
Auto Repair / Body Shops

Professional Liability
Engineers
Attorneys

Surety Bonds
Auto Dealer Bond
Construction Bond
Contract Bond
Performance Bond
Subdivision Bond
Contractor License Bond
Insurance Brokers Bond
License & Permit Bond
Mortgage Broker Bond
Payment Bond
Probate Bond
Sales Tax Bond
Miscellaneous Bonds

Insurance Brokers Bond

An insurance broker bond guarantees that the insurance broker accounts for insurance premiums to their companies, and the public. This bond protects individuals who may be harmed by the actions of a licensed insurance broker, and is required by the state department of insurance.

name:	(required)
email:	(required)
residence address:
residence phone:
cell:
business name:
business address:
business phone:
fax:
owner's name:
percentage of ownership:
years in business:
years experience in field:
type of bond requested:
bond amount:
license number:
social security number:
marital status:	married single divorced
spouse's name:	(if applicable)
driver's license number:
Do you own real estate?	yes no
Do you own a business?	yes no
annual receipts / sales:	(estimated)

Has the applicant, stockholder or indemnitor ever:

been cancelled by a surety?	yes no
had a bond claim?	yes no
declared bankruptcy?	yes no
had or have prior or pending tax liens?	yes no
had or have prior or pending lawsuits?	yes no
been convicted of a felony?	yes no