Post Club Bond Application

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, 2026 to September 30, 2027
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
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?
If yes, explain:
FULL NAME OF COVERED PERSON:
Signature of Person to be Covered:
Date

MonthDayYear
Date
Contact Phone #
Please enter a valid phone number.Format: (000) 000-0000.
IMPORTANT NOTE: Questionnaire is not valid unless ALL questions are covered. Coverage may be postponed if this form is not completed in FULL! If coverage is not renewed, terminated, or cancelled at expiration date of 10/01/2026, the Post has only 90 days to submit a Proof of Loss for prior term. After 90 days, prior coverage ceases.

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 - You would enter 3 in the Quantity section.

$7.00 Quantity
Item subtotal:

Subtotal

Tax

Total