Probate Bond Application
for New York
Applying for a bond is like applying for credit, therefore,
please make sure this information is complete and legible.
 
Assureguard EVSSL    
This Online form is on a Secure Server. Click on the seal located on left for more information on the certificate's authentication. Privacy Statement: Any information provided by a consumer or customer via our online forms WILL be held in the strictest confidence. No information will be shared with others. All submissions will be responded to within 24 hours.
 
Please submit all pertinent court documents to assist in our prompt underwriting

 

Applicant Information *required field        

Name of Applicant    Age    Phone    Email*   
Own   Rent   Street Address    City    State    Zip   
How long at this address?    SSN    Driver's Lic. No.    State   
Marital Status    Spouse Name    Your Net Worth $   
Education Level:   High School (9-12)   College (1-6)   Your relationship to the Ward or Decedent   
Present Employer    Address    Phone   
Present Occupation    How long employed?    If retired, give former occupation and how long employed 
 
HAVE YOU EVER:    1. declared bankruptcy?  Yes  NO    3. had a criminal conviction?  Yes  NO   
2. had a civil judgment?  Yes  NO    4. been bonded?  Yes  NO   
If the answer is YES to any of the above, please give a full explanation below:

 
Estate Information

Case No.    Hearing Date    Bond Amount $   
Bond to be filed in The  Court of  County, the State of   
Appointment is:   Temporary     Permanent     Successor     Additional or Co-  
Date of Appointment    If over 6 months ago. Explain reason for delay   
GUARDIAN
CONSERVATOR
  Minor   Date of Birth   
Incompetent   Date Declared Incompetent   
Name of Minor/Incompetent (Ward)  
 
Current health status of the ward 
  Where does the ward reside? 
 
What is the source of the ward's funds?  
 
Will any assets be under court restriction?
YES   NO
  Are guardian funds to be used for the support
of the ward?   YES   NO
If yes, provide copies of monthly expenditures and income
 
EXECUTOR
ADMINISTRATOR
SPECIAL ADMINISTRATOR
ADMINISTRATOR WITH WILL ANNEXED
PERSONAL REPRESENTATIVE
 
Name of Decedent  
 
Date of Death  
 
Was there a Will? YES NO   If so, date of Will    
List of names of heirs or beneficiaries of Decedent:  
     
     
     
     

 

Estate Assets

Cash $    Securities $    Debts $    Real Property $    Misc. Assets $   
Annual Income (interest, rents, SSI, etc.)   Applicant’s share In the Estate   Bank where funds will be deposited  
$
 
$
   
Bank Address    City    State    Zip   
How will securities be safeguarded (Safe deposit, Broker, etc.)   
Attorney of Record    Law firm    Attorney Phone   
Address    City    State    Zip   
Will the attorney remain involved throughout the duration of this estate?      Yes  NO    
Will professional accounting, investment or legal services be provided on an ongoing basis?      Yes  NO    
If the answer is YES to any of the following questions, please provide a full explanation.  
Is bond required on the demand of an interested party?      Yes  NO    
If Yes:    
Are there any disputes among the heirs?      Yes  NO    
If Yes:    
Does this bond replace that of another bonding company?      Yes  NO    
If Yes:    
Does Applicant replace a prior Fiduciary?      Yes  NO    
If Yes:    
Does estate contain a going business?      Yes  NO    
If Yes:    
Is Applicant indebted to the estate?      Yes  NO    
If Yes:    
Do you understand that the bond is active and premium is due each year until a Final Discharge is approved
at Court and a conformed copy is furnished to our office? 
    Yes  NO    
Do you understand that the first year’s premium is fully earned and not refundable?      Yes  NO    
Do you understand that increases or reductions in bond amount must be court approved?      Yes  NO    
Do you understand that the premium is to be paid promptly when due until the bond is released?      Yes  NO    

 

Agency Contact Agency Recommendation

Agency:    We are not familiar with the applicant  
Contact:    Applicant has been referred to us for bond placement  
Address:    The agency writes all Applicant’s insurance and highly recommend  
Phone: 
   Fax: 
  We have experience with the lawyer’s work and recommend  
Mobile:   
Email: 
 

 

Consumer Notification:
As part of the application and underwriting process: This is to inform you that a consumer report or an investigative consumer report may be obtained by the bonding company from a Consumer Reporting Agency for the purposes of reviewing and determining your eligibility for a surety bond. This report may contain information bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living from public record sources or through personal interviews with your neighbors, friends or associates. As agents of the bonding company we do not see this information nor do we as agents make any decisions based on the information. All underwriting decisions rest with the bonding company underwriter. A copy of the credit information may be obtained directly from the Consumer Reporting Agency which complied and released the information to the bonding company.

I have read and agree to the bonding company obtaining this report. (* required)

Fraud Warning:
Any person completing or filing an application to a surety, insurance company or their agents, for the purpose of obtaining bonding or insurance, knowingly, with the intent to defraud, mislead or induce, make materially false, incomplete or misleading information, or conceal information concerning any material fact, commits a fraudulent act which if convicted is a crime punishable by incarceration and subject to civil penalties as governed by the jurisdiction and applicable State and Federal statutes.

The Fraud Warning has been read and the Application Completed by (* required)

I have answered all questions above truthfully to the best of my knowledge.
  (please check box before submitting)