Below, please find the links to the application for a Lost Instrument Bond and Affidavit of Loss (the Affidavit of Loss needs to be completed in duplicate). 

Lost Instrument Bond - Application XL....PDF...
Affidavit of Loss B....PDF....

These forms must be completed, signed and notarized. Once complete, please forward to:

James A Monroe
Executive Vice President
Special Risk Managers of America, Inc.
18-B Newport Drive
Forest Hill , Maryland 21050

along with a check payable to:
Special Risk Managers of America, Inc. for the premium amount

*. The premium is calculated by the Market Value x 2%, subject to a $75. minimum. (Market Value should be determined by the closing price on the day before the date we send you the Lost Instrument Bond application.) Funds must be in USD and must be drawn on a US domiciled bank.

( * If the premium amount is over $2,000 USD, a Money Order or Wire Transfer – as described below, must be used in lieu of a check.)

As an alternative to sending a check, the premium amount can be wire transferred to:

Wachovia Bank
Account # 200012798722
Routing # 031201467

(If the wire transfer option is chosen, you must advise James Monroe of Special Risk Managers of America, Inc. (Tel.# (410) 838-4700, Email:jmonroe@specialriskmanagers.com) when the wire has been sent.)

In order for the underwriter to verify the assets as listed on the application, please include the following with your application:

A recent copy of any bank or brokerage statement evidencing the assets listed or

A letter of authority permitting Special Risk Managers of America, Inc. to contact the Bank and/or Broker to ascertain the current assets as described therein.

Please note there may be fees/charges associated with the issuance of the replacement certificate - billed by and payable to the Transfer Agent.

If the application is accepted by Special Risk Managers of America, Inc, then the Lost Instrument Bond will be forwarded to the Transfer Agent and a replacement certificate will be issued. If the application is not accepted by Special Risk Managers of America, Inc, we will contact you with the reason(s) why it was not accepted.

It will take approximately 5-10 business days for the Lost Instrument Bond(s) to be issued, provided that all of the above requested information is furnished.

If you have any questions about the completion of the application, please contact James Monroe of Special Risk Managers of America, Inc. (Tel.# (410) 838-4700, Email:jmonroe@specialriskmanagers.com).