I, the undersigned, do hereby apply to ROCHE SURETY AND CASUALTY COMPANY, INC. to act as my bail in the court  wherein I am
charged, and I agree to the following terms and conditions prescribed by the State Insurance Department.
TERMS AND CONDITIONS
The following terms and conditions are an integral part of this application for appearance bond for which ROCHE SURETY & CASUALTY
COMPANY, INC. or its Agent shall receive a premium, 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 therefore.
1. ROCHE SURETY & CASUALTY COMPANY, INC., as bail, shall have control and jurisdiction over the Defendant during the term for 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. In the event surrender of Defendant is made prior to the time set for the Defendant’s appearances, and for reason other than as
enumerated below in paragraph 3, then Defendant shall be entitled to a refund of the bond premium.
3. It is understood and agreed that the happening of any one of the following events shall constitute a breach of Defendant’s obligations to
ROCHE SURETY & CASUALTY COMPANY, INC. hereunder, and ROCHE SURETY & CASUALTY COMPANY, INC. shall have the right to
forthwith apprehend, arrest, and surrender Defendant, and Defendant shall have not right to any refund of premium whatsoever. Said
events which shall constitute a breach of Defendant’s obligation hereunder are:
(a) If Defendant shall depart the jurisdiction of the court without the written consent of the court and ROCHE SURETY & CASUALTY
COMPANY, INC., or its Agent.
(b) If Defendant shall move from one address to another without notifying ROCHE SURETY & CASUALTY COMPANY, INC., or its Agent in
writing prior to said move.
(c) If Defendant shall commit any act which shall constitute reasonable evidence of Defendant’s intention to cause a forfeiture of said bond.
(d) If Defendant is arrested and incarcerated for any offense other than a minor traffic violation.
(e) If Defendant shall make any material false statement in the application.

For good and valuable consideration, the undersigned principal hereby agrees to indemnify and/or hold harmless, ROCHE SURETY &
CASUALTY COMPANY, INC. or its Agent for any and all losses not otherwise prohibited by law, or rules and regulations promulgated under
any applicable statute.
In addition, the Defendant hereby authorizes and directs his relatives, employers, bankers, the Federal Social Security Administration, the
Internal Revenue, the state Department of Disability Insurance, the United States Armed Forces, the state Division of Motor Vehicles, all
Municipal, County, State and Federal Law Enforcement Agencies and any other persons or organizations having information concerning
the Defendant’s whereabouts to give such information to ROCHE SURETY & CASUALTY COMPANY, INC. 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 the Privacy Act and authorizes the use
of copies of this document by ROCHE SURETY & CASUALTY COMPANY, INC. and its assigns and/or duly authorized representatives.
CONFIDENTIAL
APPLICATION
WARNING – PLEASE
READ FIRST:
Any person who,
knowingly and with
intent to injure, defraud
or deceive any
insurer, files a statement
of claim or an
application containing
any false,
incomplete or
misleading information
is guilty of a felony of
the third degree.
Complete ENTIRE
Application.  Be sure to
scroll all the way down.  
Click the "Submit"
button at very bottom of
the form.
Questions?
(813) Hillsborough                                                                                                                         (727) Pinellas    

740-BAIL                              442-BAIL