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Declaration Related to Immigration Bonds

Step 1 of 3

33%
  • Section A

  • Date Format: MM slash DD slash YYYY
  • Section B

  • Section C

  • The Undersigned declares under penalty of perjury and affirms as follows:

    1. I was involved in the solicitation and/or negotiation preliminary to the execution of the above referenced bond, and/or the execution of the above referenced bond, and/or transactions of matters subsequent to the execution of the above referenced bond.
    2. I hold a valid California Fire & Casualty License.
    3. I have not charged a rate or other charge in excess of the rates and other charges that have been approved by the California Department of Insurance for Lexington National Insurance Corporation.
    4. I have not paid a commission or referral fee related to the above captioned bond to anyone who does not hold a California Fire & Casualty License.
    5. The answers set forth in Sections A and B are truthful to the best of my knowledge and belief.

Phone: 1-888-888-Bail (2245) | Lexington National | P.O. Box 6098, Lutherville, Maryland 21094

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