5049 Kongens Gade, St. Thomas, VI 00802-6487 • Tel: (340) 774-7166 • Fax (340) 774-9458
5049 Kongens Gade, St. Thomas, VI 00802-6487 • Tel: (340) 774-7166 • Fax (340) 774-9458 1131 King Street, Suite 101, Christiansted, VI 00820 • Telephone: (340) 773-6459 • Fax: (340)-719-3801 Government of the United States Virgin Islands Office of the Commissioner of Insurance Division of Banking, Insurance and Financial Regulation #5049 Kongens Gade, Charlotte Amalie, St. Thomas, V.I. 00802 TEL-340-774-7166 FAX 340-774-5590 Please Print or Type THIRD PARTY ADMINISTRATOR BOND Bond No. ___________________ KNOW ALL MEN BY THESE PRESENTS: That we, __________________________________________________________, as Principal, and ___________________________________________________, as Surety, are held and firmly bound unto the Commissioner of Insurance for the Virgin Islands and his successors in office, for the use and benefit of the Territory of the Virgin Islands and the citizens thereof, in the sum of __________________ dollars, lawful money of the United States, for the payment of which well and truly to be made, we hereby bind ourselves, our successors and assigns, jointly, severally an …
Download the original document · Plain text (TXT) · Browse the archive · How this archive works
Original source: https://web.archive.org/web/20210423061609id_/https://ltg.gov.vi/wp-content/uploads/2019/01/TPA-bond.pdf
SHA-256 21dbf3d9d09cbcc756f4adca5f9a6abdd0e2c698a77bca51edb7a426e40f4ebf
Re-using this document
A public record of the Government of the Virgin Islands, published by the agency itself. No copyright is asserted on it and 17 U.S.C. § 105 does not reach territorial government, so it publishes as a territorial public record.
Our description, tagging, arrangement, extracted text and machine transcripts are released under CC0 1.0. We assert nothing about the document itself.
Archive identifier LF-21dbf3d9d09c
Document text
5049 Kongens Gade, St. Thomas, VI 00802-6487 • Tel: (340) 774-7166 • Fax (340) 774-9458 1131 King Street, Suite 101, Christiansted, VI 00820 • Telephone: (340) 773-6459 • Fax: (340)-719-3801 Government of the United States Virgin Islands Office of the Commissioner of Insurance Division of Banking, Insurance and Financial Regulation #5049 Kongens Gade, Charlotte Amalie, St. Thomas, V.I. 00802 TEL-340-774-7166 FAX 340-774-5590 Please Print or Type THIRD PARTY ADMINISTRATOR BOND Bond No. ___________________ KNOW ALL MEN BY THESE PRESENTS: That we, __________________________________________________________, as Principal, and ___________________________________________________, as Surety, are held and firmly bound unto the Commissioner of Insurance for the Virgin Islands and his successors in office, for the use and benefit of the Territory of the Virgin Islands and the citizens thereof, in the sum of __________________ dollars, lawful money of the United States, for the payment of which well and truly to be made, we hereby bind ourselves, our successors and assigns, jointly, severally and firmly by these presents. WHEREAS the said Principal has applied to the Commissioner of Insurance of the Virgin Islands to be licensed as a Third Party Administrator in the Territory of the Virgin Islands and is legally required to give bond unto the Commissioner of Insurance for the Territory of the Virgin Islands to guarantee the payment of all claims or other legal obligations which the Principal fails to pay, up to the amount of this bond, which arise from the operations of the Principal in the Territory of the Virgin Islands. NOW, THEREFORE, this bond will continue in full force and effect until terminated in the following manner. This bond may be cancelled by the Insurance Commissioner for the Territory of the Virgin Islands by written notice from the Insurance Commissioner to the Surety hereon, which notice shall specify the date of termination of the bond. Cancellation by the Surety Company will not be effective until 90 days following receipt of written notice to the Insurance Commissioner and Principal. Third Party Bond 5049 Kongens Gade, St. Thomas, VI 00802-6487 • Tel: (340) 774-7166 • Fax (340) 774-9458 1131 King Street, Suite 101, Christiansted, VI 00820 • Telephone: (340) 773-6459 • Fax: (340)-719-3801 IN WITNESS WHEREOF, the parties herein have caused this bond to be executed this ____ day of ____________, 20____. ____________________________ Principal ____________________________ By ____________________________ Witness ____________________________ ____________________________ Surety ____________________________ By ____________________________ Witness FOR OFFICE USE ONLY Receipt Number: _______________________ Date: __________________ Amount: $_________________