Financial Statement and Indemnity Agreement

Name of Indemintor

First Name Middle Name Last Name

Phone Number

Please enter a valid phone number.

Date of Birth

Date

Residence Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Social Security No.

Email

example@example.com

Phone Number

Please enter a valid phone number.

Employed By:

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Spouse's Name

Date of Birth

Date

Email

example@example.com

Employed By:

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email

example@example.com

Parents

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

List Personal References (Including Name, Work or Home Address, and Phone)

Assets (List $ Value of each section):

Cash in   Type a label   , Bank Stocks, bonds, mortgages (market value):   Type a label
Real estate, the title to which is in my name alone:
A.   Type a label
B.   Type a label
Accounts receivable   Type a label
Other assets (in detail)   Type a label

Liabilities (List $ Value of each section):

Money borrowed on notesType a label
Mortgages on real estate scheduled opposite:
A.   Type a label
B.   Type a label
Accounts Payable   Type a label
Other Liabilities (in detail):   Type a label

The make of the above statement hereby authorizes the Surety to confirm the bank balances claimed and all other items comprising said statement.

YOU ARE ASSUMING SPECIFIC OBLIGATIONS – READ CAREFULLY!
INDEMNITY AGREEMENT

THIS AGREEMENT is made by and between the undersigned Defendant, Indemnitors, and Palmetto Surety Corporation through its duly authorized
Agent
WHEREAS, Palmetto Surety Corporation (hereinafter called “Surety”), at the request of the Indemnitors has or is about to become SURETY
on an appearance bond for Defendant in the sum of   Type a label   Dollars ($   Type a label   ) by its certain bond executed on power of attorney number(s)   Type a label   ,   Type a label   ,   Type a label   ,   Type a label

NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties jointly and severally agree as follows:
1. For good and valuable consideration, the undersigned principal agrees to indemnify and hold harmless the surety company or its agent for all losses not otherwise prohibited by law or by rules of the Department of Financial Services.
2. That the Indemnitors will have Defendant forthcoming before the Court named on said Bond at the time(s) therein fixed, and at such other times as may be ordered by the Court. 3. That the Indemnitors will at all times indemnify and save the Surety harmless from and against any and all claims, demands, liabilities, costs, charges, counsel fees, expenses, suits, orders, judgements, or adjudications whatsoever which the Surety shall or may for any cause sustain or incur, by reason of Surety having executed said Bond or undertaking, and will, upon demand, place the Surety in funds to meet all such claims, demands, liabilities, costs, charges, counsel fees, expenses, suits, orders, judgments, or adjudications against it, by reason of its Suretyship, and before the Surety shall be required to pay the same.
4. That the agreement of indemnity contained in paragraph 2 above shall continue as long as the SURETY has any liability or has sustained any loss, upon the bond referred to herein, and the undersigned further agrees not to make any transfer, or any attempted transfer of any of the property, real or personal, in which the undersigned has an interest or in which the undersigned may subsequently acquire any interest, and it is further agreed that the SURETY shall have a lien upon all property of the undersigned for any sums due it or for which it has become, or may become, liable by reason of its having executed the bond referred to herein. It is further agreed that the Indemnity Agreement contained in Paragraph 2 above and the provisions of this paragraph shall be binding upon and apply to any subsidiary, affiliate, parent or related enterprised created or acquired by the undersigned.
5. The voucher, or any other evidence of any payment made by the Surety, by reason of this Suretyship, shall itself, be conclusive evidence of such payment as to the indemnitors, their estate, and those entitled to share in their estate, and their successors and assigns. 6. That the Surety may withdraw, at any time provided by law, from its Suretyship upon the Bond or undertaking herein, without liability to any party.
7. That Indemnitors’ liability to Surety is not limited to the Bond referred to herein, but shall apply to all other bonds or undertakings issued by Surety at the request of the indemnitors. 8. The Indemnitors’ obligations and indemnities as contained herein shall not terminate upon exoneration of the bond or undertaking but shall continue until such time that Surety is relieved of all duties, demands, liabilities, obligations, costs or expenses in any way related thereto.
9. That the waiver by Surety of any breach of any term or conditions herein shall not be deemed a waiver of same of any subsequent breach of the same term or condition, and that failure of any Indemnitor to comply with the terms and conditions herein shall not act as or be construed as a release or waiver as the remaining Indemnitor who shall remain liable and bound by all provisions of this Agreement.
10. This Agreement shall be construed and enforced under the laws of the State of   Type a label   In the event any of the
provisions of this Agreement are inconsistent with the laws of this State, this Agreement, as to these provisions only, shall be null and void, and the remainder shall be enforced with
the same effect as though such provisions were omitted.
11. The use of the plural herein shall include the singular. Obligations of the Indemnitors shall be joint and several and the provisions of this Agreement shall be binding upon Indemnitors’
heirs, successors, representatives and assigns.
IN WITNESS WHEREOF, the parties have executed this Agreement this   Type a label   day of   Type a label   ,   Type a label

TERMS AND CONDITIONS

ALL INFORMATION BELOW MUST BE COMPLETED IN FULL, OR DELAY WILL OCCUR

Name of defendant

First Name Last Name

Nickname/Alias

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

How long

Former Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

How long

Phone Number

Please enter a valid phone number.

Defendant Email

example@example.com

Employed by

Boss

How long

Employer's address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Previous employment

How long

Date of Birth

Date

Height

Weight

Eyes

Hair

Race

Select what applies

Left Handed Right Handed Glasses Dentures Beard/Mustache Identification marks or tatoos

Social Security No.

Spouse's Employment

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Children's Name and Ages

School

Parent's Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Spouse's Parents

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Brothers or Sisters

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Brothers or Sisters

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Brothers or Sisters

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Best Friend

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Defendant's Attorney

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Defendant Arrested Before? If yes list conviction, and offense:

Automobile Information:

Year

Make

Model

Color

License No.

When and where did you buy the car?

Amount owing

To whom

Driver's License No.

State

Social Media Login/Password:

Are you under any bail bond now? If so list Agent or Surety:

Remarks:

The Defendant hereby affirms that the foregoing declarations made and answers given are the truth without reservation and are made for the purpose of inducing
the Surety to become surety or to procure suretyship on the bond or undertaking applied for herein, with the intent and purpose that they be relied on fully.
In addition, the Defendant hereby authorizes and directs his relatives, employers, bankers, the Federal Social Security Administration, the Internal Revenue,
the state Department of Disability Insurance, the United States Armed Forces, the state Division of Motor Vehicles, all Municipal, County, State and Federal Law
Enforcement Agencies and any other persons or organizations having information concerning the Defendant’s whereabouts to give such information
to Palmetto Surety Corporation and its assigns and/or duly authorized representatives. The Defendant understands that any information obtained will
be used for the purpose of securing his or her appearance and/or apprehension for Court appearance, and for the purpose of securing reimbursement
for any expenses incurred as a result of Defendant’s non-appearance. The Defendant hereby waives his or her rights with respect to the Privacy Act and
authorizes the use of copies of this document by Palmetto Surety Corporation and its assigns and/or duly authorized representatives. In addition, if the
Defendant escapes from the custody of Palmetto Surety Corporation and is subsequently captured in a State of the United States other than the one
in which the original charge was filed, or in a foreign country, the Defendant does hereby agree to return voluntarily to the State of original jurisdiction,
and does hereby waive extradition proceedings and further consents to the application of such force as may be necessary to effect such return.

Signed and delivered thisblanksday of Type a label , Type a label

PROMISSORY NOTE

$ Type a label Type a label
On demand after date, for value received, Type a label Promise to pay to the order of Palmetto Surety Corporation or assigns Type a label DOLLARS, at Type a label , with interest thereon at the rate of Type a label per cent, per annum from Call Date until fully paid. Interest payable semi-annually. The make and endorse of this note further agree to waive demand, notice of non-payment and protest; and in case suit shall be brought for the collection hereof, or the same has to be collected upon demand of an attorney, to pay reasonable attorney’s fees for making such collection. Deferred interest payments to bear interest from maturity at Type a label per cent, per annum payable semi-annually. It is further agreed and specifically understood that this note shall become Null and Void in the event the said defendant Type a label shall appear in the court at the time or times so directed by the Judge or Judges of competent jurisdiction until the obligations under the appearance bond or bonds posted on behalf of the defendant have been fulfilled and the Surety discharged of all liability thereunder, otherwise to remain in full force and effect.

YOU ARE ASSUMING SPECIFIC OBLIGATIONS – READ CAREFULLY! INDEMNITY AGREEMENT

TERMS AND CONDITIONS

PROMISSORY NOTE

YOU ARE ASSUMING SPECIFIC OBLIGATIONS – READ CAREFULLY!
INDEMNITY AGREEMENT