Def Application!

Ali Baba Bail Bonds LLC Defendant Contract & Promissory Note
How Many bonds does the defendant have
1stPower NO.
1st Bond
1stPremium
1stDocket NO.
1stCharges
1stPower

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Cancel of
2ndPower NO.
2nd Bond
2ndPremium
2ndDocket NO.
2ndCharges
2ndPower

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Cancel of
3rdPower NO.
3rd Bond
3rdPremium
3rdDocket NO.
3rdCharges
3rdPower

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Cancel of
4th PowerNO
4th Bond
4tPremium
4thDocket NO.
4thCharges
4thPower

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Cancel of
5th PowerNO.
5th Bond
5thPremium
5thDocket NO.
5thCharges
5thPower

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Cancel of
6th PowerNO.
6th Bond
6thPremium
6thDocket NO.
6thCharges
6thPower

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Cancel of
7th PowerNO.
7th Bond
7thPremium
7thDocket NO.
7thCharges
7thPower

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Cancel of
8th PowerNO.
8th Bond
8thPremium
8thDocket NO.
8thCharges
8thPower

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Cancel of
9th PowerNO.
9th Bond
9thPremium
9thDocket NO.
9thCharges
9thPower

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Cancel of
10th PowerNO.
10th Bond
10thPremium
10thDocket NO.
10thCharges
10thPower

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Cancel of
Please have your Identification & Paystub ready.

Identification, e.g., Drivers license, Passport, Greencard

Note: This application will request the submission of your identification & paystub. Please have a scanned image, screenshot, or photocopy of your paystub & ID ready. The process can be done quickly with your smartphone.

Click Next, when you are ready to begin.

Defendant Information
Defendant's Name

First Name Middle Name Last Name
Defendant' Date of Birth

Month Day Year
Defendant' Social Security Number
This information is necessary for identity verification & background check
Defendant' Gender

Male Female

Place of Birth
Were you born in the U.S.A.? *

Yes I was born in the U.S.A. No, I was not born in the U.S.A

U.S.A. Citizen Status
What is your U.S.A. citizen status? *

Permanent Resident "Green Card" Naturalized Citizen

Immigration Status
What is your country of origin?
In What Court did your naturalization oath ceremony take place at?
In What year did you become a green-card holder?

Month Day Year
in What year did you become a naturalized citizen?

Month Day Year

Employment
Are You Currently Employed? *

Yes, I am Currently Employed No, I am not Currently Employed

Vehicle Information
Do You own/lease a Vehicle? *

Yes, I own/lease a Vehicle No, I do not own/lease a Vehicle

Home Owner
Are you a home owner? *

Yes, I own a home No, I do not own a home

Lease Information
Is the lease at your rented address in Your Name? *

Yes, I rent and the lease is in my name No, the lease is not in my name

Lease Holder
Who is the lease holder at your residence?

First Name Last Name
What is their relationship to you?
Phone Number

Your Residence

Your Home Address

Street Address
Street Address Line 2
City	State
Zip Code	Country

How long have you lived at your current residence?

0 - 6 months 6 months - 1 year 1 - 2 years 2 or more years

Your Contact Information
Your Mobile Number
Social Media Name
i.e. facebook / instagram / snapchat
Your Email
example@example.com

Contact & Reference

Neighbor, Friend, Family-member , Co-worker or Associate not signing for the bond
1st Reference Relationship to You?
2nd Reference Relationship to You?
3rdt Reference Relationship to You?
4th Reference Relationship to You?
5th Reference Relationship to You?

1st Contact & Reference
Enter your {1stReference211}'s information as 1st Reference
1st Reference

First Name Last Name
1st Reference Phone Number

1st Reference Address

Street Address
Street Address Line 2
City	State
Zip Code	Country

Contact & Reference
Please enter your {2ndReference212}'s information as 2nd Reference
2nd Reference

First Name Last Name
2nd Reference Phone Number

2nd Reference Address

Street Address
Street Address Line 2
City	State
Zip Code	Country

3rd Contact & Reference
Please enter your {3rdtReference}'s information as 3rd Reference
3rd Reference

First Name Last Name
3rd Reference Phone Number

3rd Reference Address

Street Address
Street Address Line 2
City	State
Zip Code	Country

4th Contact & Reference
Please enter your {4thReference}'s information as 4th Reference
4th Reference

First Name Last Name
4th Reference Phone Number

4th Reference Address

Street Address
Street Address Line 2
City	State
Zip Code	Country

5th Contact & Reference
Please enter your {5thReference}'s information as 5th Reference
5th Reference

First Name Last Name
5th Reference Phone Number

5th Reference Address

Street Address
Street Address Line 2
City	State
Zip Code	Country

Your Vehicle Information

State the Vehicle is Registered in

Color of your Vehicle
Make & Model of your Vehicle
Plate Tag #
Year	Country

Plate / Tag #
Color of your Vehicle
Make & Model of your Vehicle
Year of your Vehicle

Employment Information
What is the name of the company you work for?
What is your occupation?
What is your average weekly income?

Employment Address & Contact

Work Address

Street Address
Street Address Line 2
City	State
Zip Code	Country

Your Employer's Phone Number

Defendant's Bond Information
What is the defendants' bond Amount *
Surety Bond amount
What State did the defendant get arrest in? *

New York Connecticut
NY premium
ct Premium
Where is the Defendant Incarcerated?
Provide the location where the defendant is detained, i.e., the name of the police department, jail or courthouse?
Does the Defendant have prior arrest?

Yes, the defendant has a prior arrest No, this is the defendant's first arrest

Documents Needed

Have your identification & paystub ready
Take a Photo/Selfie of yourself

Browse Files
Tip: You can use your front or back camera on your mobile phone Cancel of
Take a Photo of your Identification

Tap here
You can use your Drivers license or passport. Tip: You can use your camera or upload from your browser. Cancel of
Take a Photo of your Paystub

Tap here
Tip: You can use your camera or upload from your browser. Cancel of

Documents Needed

Have your identification ready.
Take a Photo of your Green Card

Tap Here
Tip: You can use your camera or upload from your browser. Cancel of
Take a Photo of your Passport

Tap Here
Tip: You can use your camera or upload from your browser. Cancel of

Bond & Premium
Bond Amount
Total Premium
The total premium will be adjusted if there are multiple bonds
The Premium of the Bond will be paid in full today? *

Yes, the premium will be paid in full today No, Need to apply for a Payment Plan

Payment Plan Options
Installment Payment Plan (select one)

Weekly (60 payments or less) Bi-weekly (30 payments or less) Monthly (15 payments or less)
Payment due Date

Month Day Year

Premium Downpayment
Premium of the Bond
Premium Downpayment
Fill in the agreed-upon down payment discussed with the Bail Agent here.
min Premium Downpayment
UnPaid Balance
The total Unpaid Balance will be adjusted if there are multiple bonds. (Must be fully paid within 15 months by CT Public Act 11-45)

The down-payment was not approved. Enter the down-payment amount that you discussed with your Bail Agent!

Tap on the back button to make a correction on the premium down payment

Terms & Condition Contract
Defendant Agreement & Contract *

Payment Plan Contract *

Signature

Final Step!
"Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning"
"any fact material thereto commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for" "each such violation.."
I, {defendantsName}, the undersigned Defendant (“Defendant” or “you”), hereby represent and warrant that the following declarations made, and answers given are true, complete and correct and are made for the purpose of inducing Ali Baba Bail Bonds LLC. (“Surety”) to issue, or cause to be issued, bail bond(s) or undertaking(s) for you (singularly or collectively the “Bond”). Agree to the terms set forth on All Pages of this Agreement.
Signature *
Who was your Bail Agent?
Was Your Bail Agent Helpful?
Today's Date

Month Day Year
Should be Empty:

Ali Baba Bail Bonds LLC Defendant Contract & Promissory Note

Defendant Information

Place of Birth

U.S.A. Citizen Status

Immigration Status

Employment

Vehicle Information

Home Owner

Lease Information

Lease Holder

Your Residence

Your Contact Information

Contact & Reference

1st Contact & Reference

Contact & Reference

3rd Contact & Reference

4th Contact & Reference

5th Contact & Reference

Your Vehicle Information

Employment Information

Employment Address & Contact

Defendant's Bond Information

Documents Needed

Documents Needed

Bond & Premium

Payment Plan Options

Premium Downpayment

Terms & Condition Contract

Signature