HOME OFFICE MAILING ADDRESS
500 NEW YORK AVENUE P.O. BOX 41400
DES MOINES, IOWA 50313-4908 DES MOINES, IOWA 50311
(877) 349-6588 (515) 309-1351
FAX (877) 349-6590 FAX (515) 954-3300
LOST INSTRUMENT BOND
herein called the Principal, and MERCHANTS BONDING COMPANY (MUTUAL), a corporation licensed to do
business in the State of , as Surety, are held and firmly bound unto
herein called the Obligee,
in the penal sum of ( ).
WHEREAS, The said
issued to and in the name of
certain herein called the ''Instrument''
and the Principal alleges that the Instrument has been lost or destroyed.
AND WHEREAS, the Principal has applied to the Obligee for a new instrument and the Obligee is willing to issue
a new instrument, in lieu of the Instrument lost or destroyed, as aforesaid, upon the execution of a Bond of
Indemnity against any and all loss or damage, not to exceed the amount of the penal sum mentioned in the above
obligation, which may arise to the Obligee from the use of the Instrument so lost or destroyed, or from the issue of
said new instrument.
NOW THE CONDITION OF THIS OBLIGATION IS SUCH, That, if the above bounden Principal, heirs, executors,
and administrators, shall and do, from time to time, and at all times hereafter, well and sufficiently indemnify, save
and keep harmless the Obligee, heirs, executors, and administrators, successors and assigns, from and against
any use of the Instrument herein before particularly described, and from and against all claims, demands, suits,
actions, payments, loss, damage, cost and expense to which the Obligee, heirs, executors, and administrators,
successors or assigns, shall or may be subjected by reason of or growing out of the loss or destruction of the
Instrument, as above recited, and by reason of or growing out of the issue of the said new instrument in lieu of the
Instrument so lost or destroyed; and, if the above bounden Principal, heirs, executors or administrators shall and
do surrender or deliver to the Obligee the lost Instrument, if found, then this obligation is to be void, otherwise to
be and remain in full force and virtue.
Signed, sealed and dated on this day of , .
Countersigned (if required):
MERCHANTS BONDING COMPANY (MUTUAL)
MSC 0880 (7/10)