CLUB BOND APPLICATION 2025-26

QUESTIONNAIRE FOR CLUB EMPLOYEES & BINGO PERSONS

THIS BOND APPLICATION CAN BE USED FOR BINGO CHAIRPERSON, CANTEEN MANAGER, AND SECRETARY. THIS FORM MUST BE COMPLETED IN FULL!
Coverage Term: October 1, 2025 to September 30, 2026
Name of Post*
Post*
Post Address*
STREET, CITY, STATE, & ZIP
Name of Person to be Covered*
Position to be Covered*
Bingo Chairperson, Canteen Manager, Canteen Employee etc.
Coverage Amount Requested*
$3,000 MINIMUM
Post - Annual Income*
Has the Post had any crime losses (Theft of Money by Employees) over the past three years? If you answered YES, please contact Department Headquarters for a Loss Questionnaire*

YESNO
If yes, provide a description along with the date and amount of the loss.
Has you ever been convicted of any dishonest or fradulent employement related acts, for example: burglary, robbery, theft, or embezzlement of funds of any kind?*

YESNO
IF COVERAGE IS NOT RENEWED, TERMINATED, OR CANCELLED AT EXPIRATION DATE, THE POST HAS ONLY 90 DAYS TO SUBMIT A PROOF OF LOSS FOR PRIOR TERM, AFTER 90 DAYS, PRIOR COVERAGE CEASES.
FULL NAME OF COVERED PERSON:

First NameLast Name
Signature of Person to be Covered:*

Clear
Date*

MonthDayYear
Date
Contact Phone #
Please enter a valid phone number.

CLUB BOND PAYMENT*

Club Bond Manager Bond Payment Price is $7.00 per 1,000. In the Quantity Section enter Number of 1,000. Example: For a 3,000 Bond - I would enter 3 in the Quantity section.

$7.00 Quantity
Item subtotal:$0.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

Should be Empty:

Coverage Term: October 1, 2025 to September 30, 2026

Credit Card