Office of the Lieutenant Governor, VI · St. Thomas
Third Party Administrator Bond
This bond is completed by a third-party administrator applicant and its surety to guarantee covered claims or legal obligations arising from the applicant’s operations.
What this form is
The bond supports an application to the Commissioner of Insurance for a third-party administrator license and guarantees payment of covered claims or other legal obligations the principal fails to pay, up to the bond amount. The document identifies the principal, surety, bond amount, and execution date, and includes signature lines for the principal, surety, and witnesses. It also describes how the bond may be cancelled.
Who needs it
A third-party administrator applicant and its surety complete and sign this bond in connection with the applicant’s license application.
How to submit it
The form names the Commissioner of Insurance and lists the Division of Banking, Insurance and Financial Regulation at #5049 Kongens Gade, Charlotte Amalie, St. Thomas, V.I. 00802. It does not give a submission method.
About notarization
This bond is signed and dated without a notary; it includes witness signature lines but no notarized attachment or sworn step.
How to submit this form
- 1
Download The Bond
Download the Third Party Administrator Bond PDF.
- 2
Complete The Bond Details
Print or type the principal and surety names, bond amount, and execution date.
- 3
Gather Signatures
Have the principal, surety, and witnesses sign in the spaces provided.
- 4
Submit To The Commissioner
Submit the bond to the Commissioner of Insurance; the form lists the Division of Banking, Insurance and Financial Regulation address.
Frequently asked questions
- What is the Third Party Administrator Bond for?
- It guarantees payment, up to the bond amount, of covered claims or other legal obligations the principal fails to pay that arise from its operations in the U.S. Virgin Islands.
- Who completes the bond?
- The bond identifies a principal and a surety. Both have signature lines, as do witnesses; the form also asks for a bond amount and execution date.
- Do I need a notary for the Third Party Administrator Bond?
- No. This bond is signed and dated without a notary. It includes witness signature lines but does not identify a notarized attachment or sworn step.
- How do I submit the Third Party Administrator Bond?
- The form names the Commissioner of Insurance and lists the Division of Banking, Insurance and Financial Regulation at #5049 Kongens Gade, Charlotte Amalie, St. Thomas, V.I. 00802; it does not specify a submission method.
Need something notarized?
This Third Party Administrator Bond doesn’t need a notary — but if you have another Office of the Lieutenant Governor form that does, a commissioned online notary can help.