Application for Appearance Bond


  • and I agree to the following terms and conditions prescribed by the State Insurance Department
  • MM slash DD slash YYYY
  • Terms and Conditions continued on back of form.


  • The following terms and conditions are an integral part of this application for appearance
  • MM slash DD slash YYYY
  • for which O'SHAUGHNAHILL SURETY & INSURANCE, INC.,or its Agent shall receive a premium in the amount of
  • and the parties agree that said appearance bond is conditioned upon full compliance of all said terms and conditions and is a part of said bond and application therefor


  • MM slash DD slash YYYY
  • The Defendant hereby affirms that the foregoing declarations made and answers given are the truth without reservation and are made for the purpose of inducing O’Shaughnahill Surety & Insurance, Inc. (the “Surety”) to become surety or to procure suretyship on the bond or undertaking applied for herein, with the intent and purpose that they be relied on fully.

    In addition, the Defendant hereby authorizes and directs his relatives, employers, bankers, the Federal Social Security Administration, the Internal Revenue Service, Enforcement Agencies and any other persons or organizations having information concerning the Defendant’s whereabouts to give such information to the Surety and its assigns and/or duly authorized representatives. The Defendant understands that any information obtained will be used for the purpose of securing his or her appearance and/or apprehension for Court appearance, and for the purpose of securing reimbursement for any expenses incurred as a result of Defendant’s non-appearance. The Defendant hereby waives his or her rights with respect to all applicable federal and state privacy laws and authorizes the use of copies of this document by the Surety and its assigns and/or duly authorized representatives. In addition, if the Defendant escapes from the custody of the Surety, and is subsequently captured in a State of the United States other than the one in which the original charge was files, or in a foreign country, the Defendant does hereby agree to return voluntarily to the State of original jurisdiction, and does hereby waive extradition proceedings and further consents to the application of such force as may be necessary to effect such return.

    Signed and delivered this____________ day of ______________________, 20__________


    1. O’SHAUGHNAHILL SURETY & INSURANCE, INC., a surety, shall have control and jurisdiction over the Defendant during the term of which the bond is executed and shall have the right to apprehend, arrest and surrender the Defendant to the proper officials at any time as provided by law.
    2. O’SHAUGHNAHILL SURETY & INSURANCE, INC. or its Agent has the right to use special technology in order to track a Defendant for the duration of this bond. This could include, but not limited to phone tracing and GPS monitoring.
    3. In the event surrender of Defendant is made prior to the time set for Defendant’s appearances, and for reason other than as enumerated below in paragraph 4, then Defendant shall be entitled to a refund of the bond premium.
    4. It is understood and agreed that the happening of any one of the following events shall constitute a breach of Defendant’s obligations to O’SHAUGHNAHILL SURETY & INSURANCE, INC. hereunder, and O’SHAUGHNAHILL SURETY & INSURANCE, INC. shall have the right to forthwith apprehend, arrest, and surrender Defendant, and Defendant shall have no right to any refund of premium whatsoever. Said events which shall constitute a breach of Defendant’s obligations hereunder are:
      1. If Defendant shall depart the jurisdiction of the court without written consent of the court and O’SHAUGHNAHILL SURETY & INSURANCE, INC., or its Agent.
      2. If Defendant shall move from one address to another without notifying O’SHAUGHNAHILL SURETY & INSURANCE, INC., or its Agent in writing prior to said move.
      3. If Defendant shall commit any act which shall constitute reasonable evidence of Defendant’s intention to cause a forfeiture of said bond.
      4. If Defendant is arrested and incarcerated for any offense other than a minor traffic violation.
      5. If Defendant shall make any material false statement in the application.