Bankers Insurance Company

 

Application And Agreement For Surety Bail Bond
DEFENDANT'S NAME
POWER OF ATTORNEY No.
AMOUNT
EXEC. DATE:
ARR. DATE:
BOOKING NAME
AKA NAME (S)

BOOKING INFORMATION
Booking #
Where Held
Charges
Court
JUD. Dist.
At
County
Case#
Date To Appear
Time
F.B.I.#
C.I.J.#
Arrested By:
Where Arr.
Co-Defendants

DEFENDANTS INFORMATION
St. Add.
City
State
ZIP
Phone
Cell Phone
How Long
Former Add.
ZIP
How Long
Years in City
County
State
Last County
Last State
Employed By
OCC
Phone
How Long
Employer's Add.
Superior
How Long
Pre. Employer
Address
When
DOB
Sex
Height
Weight
Hairs
Eyes
S.S#
D.L.#
I.D. Marks
Race
Moustache
Glasses
Where Born
Prev. Arrest Charg.
Court
County
When
Disposition
Prev. Bal
With Whom
Amt
Case Pending
On Probation
Where
Probation Officer
Where Arrested
Co-Defendants
Vehicle Make
Model
Year
Color
LIC#
Military Branch
SER. #
Discharge Date
Union
Local

DEFENDANT'S  FAMILY INFORMATION
Spouse
Address
Phone
How Long
Employer
Address
Phone
How Long
Marriage Date
Where
Maiden Name
D.O.B.
Prev. Spouse
Address
City
Phone
Children Name & Age
Defendant's Mother
Address
Phone
Defendant's Father
Address
Phone
Spouse's Mother
Address
Phone
Spouse's Father
Address
Phone
Defendant's Brother
Address
Phone
Defendant's Sister
Address
Phone
Best Friend
Address
Phone
Defendant's Attorney
Signature of Defendant
Date

INDEMNITOR INFORMATION
Indemnitor's Name
D.O.B.
S.S. #
D.L. #
Address
Phone
Cell Phone
Rel. To Def.
Employed By
Address
Phone
Occupation
How Long
Superior
Monthly Income
Bank
Branch
Acct.#
Type
Balance
Spouse
Address
Phone
Employed By
Address
Phone
Vehicle Make
Model
Year
Color
L.I.C. #
Registered Owner
Legal Owner
Lien
Real Property
In Who's Name
How Long
Value
Equity
Financed By
Amount
Reference
Address
Phone
Family Reference
Address
Phone
Relation
Notations

 

 

I certify that the above information is correct and true.

 
Signature of the Indemnitor
Date

 

 

Statement of Information Required By Section 2100, Califoria Administration Code
Full Name of Person Supplying Information
Name of Person Negotiating Bail
Name of Person Recieving Information
Address
Address
Date and Time Information Recieved
Connection or Relationship to Defendant
Connection or Relationship to Defendant
Manner in Which Information Recieved
If Same Was Defendant, How did He Communicate?
Name of Licensee Who Negotiated Tranaction
Name of Other Agent Involved and Commission Paid
If Writ Name of Attorney
Name and Sum Paid to Unlicensed Persons and Services Performed
Was Consideration Other Than Money Recieved?
Yes
No
If Yes, Explain in Details and Attach Statment

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