We, _________________________________________ (claimant), of __________ _________________________________________ (address), ________________ (city), ______________ (county), __________ (state), as principal, and __________ (surety), a corporation organized and existing under the laws of __________ (state), and duly licensed to transact a surety business in __________ (state), as surety, acknowledge our indebtedness to __________ (obligee), of ____________________ ______________ (address), ____________ (city), __________ (county), _________ (state), as obligee, as well as its successor and assigns, in consideration for the release of the goods subject to __________ (warehouse receipt) number __________, in the sum of __________ Dollars ($__________), in order to indemnify the obligee, its successor and assigns against all loss, damage, charges, or other expenses reasonably incurred by obligee by reason of claimants failure to return such document on surrender by obligee of the goods.


The condition of the foregoing obligation is that:


1.     Obligee has received on ________________ (month & day), ______ (year), the following described goods from claimant and has issued its original __________ (warehouse receipt), number __________, dated __________ (month & day), ______ (year), covering these goods:  __________________________________________________ (describe goods).


2.     Principal has represented to obligee that:


a.    The above described document which is missing is lost, stolen, or destroyed; and


b.    Principal is the owner of these goods and the person entitled under this document to the delivery of the goods; and

c.    Principal has requested delivery despite principals failure to produce and surrender the above described missing document covering these goods; and


d.    Principal has agreed to indemnify obligee and any other person for any loss, injury, or expense arising out of principals failure to surrender the document.


3.    The goods represented by the missing document, issued by obligee, bearing number __________, and dated ___________ (month & day), _______ (year), have been delivered by obligee to principal without surrender of such document in the good faith belief that principal is the owner entitled to the goods and that the above described document representing such goods is lost, stolen, or destroyed.


This obligation shall be void if the above described document is found and principal delivers such document to obligee for cancellation.


This bond is executed pursuant to ________________________ (cite local enactment of UCC § 7-601), and is intended to comply with all requirements of such statute.


The premium, for which this bond is written, is ___________ Dollars ($__________).


In witness whereof, the parties have executed this bond at __________ (designate place of execution) on __________ (month & day), ______ (year).



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(Signature)                                                                             (Date)


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(Signature)                                                                              (Date)