FIS 0508 (04/11) Office of Financial and Insurance Regulation Page 1 of 2 Debt Management Surety Bond for Licensee Bond Number: _____________________________ That ____________________________________________________________________________________________________ (Name of Firm or Person if Sole Proprietor) operating as _______________________________________________________________________________________________________________________ (Name of Firm) _________________________________________________________________________________________________________________________________ (State of Corporation, Partnership, Limited Liability Company, or Individual) _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ (List Complete Address of all Offices covered by this Bond) as Principal and _______________________________________________________________________________________________, a Surety Company authorized to transact business in Michigan, as surety, are held and firmly bound unto the People of the State of Michigan in the penal sum of ___________________________________ lawful money of the United States, to be paid ($25,000-$100,000) to the people of the State of Michigan, for which payment will and truly be made, we bind ourselves and our heirs, executors, administrators, personal representatives, and successors, jointly and severally, firmly by these presents. WHEREAS, the said _______________________________________________________________________________ (Name of Firm) principal obligor herein, is filing herewith an application to the Michigan Office of Financial and Insurance Regulation for a license to engage in the business of debt management at the office(s) listed above under the provisions of Act 148, Public Acts of 1975, as amended; and WHEREAS, Section 5 of said Act 148 provides, in part, as follows: “The amount of the surety bond must equal or exceed the total amount of Michigan client’s funds in the applicant’s or licensee’s trust account at the time of the application for license or renewal, as determined by the department, but in no event shall a surety bond be less than $25,000 or be greater than $100,000. The surety bond shall be conditioned on the faithful accounting of all money collected upon accounts entrusted to a license engaged in the business of debt management or the licensee’s employees and agents.” NOW, THEREFORE, the condition of this obligation is such that if he said principal obligor herein shall faithfully account for all monies collected upon accounts entrusted to him and his employees and agents, then this obligation shall be void; otherwise the same shall be in full force and effect. PROVIDED, HOWEVER, in no event shall be the aggregate liability of the surety under this bond for any and all claims to one or more claimants exceed the penal sum of this bond. American LegalNet, Inc. www.FormsWorkFlow.com FIS 0508 (04/11) Office of Financial and Insurance Regulation Page 2 of 2 Debt Management Surety Bond for Licensee Bond Number: _____________________________ The Surety may at any time terminate its obligation hereunder by giving thirty (30) days written notice to said Principal and to the Michigan Office of Financial and Insurance Regulation, P.O. Box 30220, Lansing, MI 489098201, in which even the liability of the Surety shall at the expiration of the said thirty (30) days cease and terminate, except as to such liability of the Principal occurring prior to the expiration of the said thirty (30) days. If the Surety provides 30 days notice of termination of the Bond, the Principal, if continuing in the debt management business, shall furnish a satisfactory new bond before the expiration of the said thirty (30) day period. This bond becomes effective as of _____________________________________, _______, in support of the license(s) issued for the term ending December 31, __________. IN WITNESS WHEREOF, the parties hereto have hereunto set our hands and affixed our seals this ____________________day of _____________________, ____________. __________________________________________________ (Seal) (Name of Firm) By __________________________________________________________________ (Officer, Partner, Member, or Sole Proprietor) __________________________________________________ (Seal) By __________________________________________________________________ 1975 PA 148 Sec. 5 as amended requires submission of this form by applicants for a license to do business as a Debt Management company. Failure to complete and submit this form properly could result in denial, suspension or revocation of your license. When complete, please mail with Original Bond to: OFIR Consumer Finance Licensing Unit PO Box 30220 Lansing MI 48909-7720 Our delivery address is: OFIR Consumer Finance Licensing Unit 611 W Ottawa St Lansing MI 48933-1020 American LegalNet, Inc. www.FormsWorkFlow.com