Bud Scully, Chairman

Joe Scully, President

Applications, Forms & Descriptions

(Files are in Microsoft Word Format unless otherwise noted)

In-Organization (De-Novo) Application (For Financial Institution Applicants less than one year old) Location Description Questionnaire Workers' Compensation Application Workers' Compensation Officer Employee Payroll form-'08 Community Bank Application (less than $150MM Assets) Financial Institution Application (more than $150MM Assets) Directors & Officers Liability Insurance Application for Indication (generic form) (.PDF file) Internet Banking Liability Application REO Application (.PDF file)

Lender Force-Placed Insurance:    New Account Application    Force-Placed Request Form    Insurance Form for REO & FP Mortgage Protection Policy Application and Survey Form (.PDF file) Secured Creditor Impaired Property Portfolio Application (.PDF file) Excess Deposit Bond:    Overview (.PDF file)    Application Employment Practices Liability Application for Indication (generic form) (.PDF file) Directors & Officers Liability Insurance (Side A) Application (.PDF file) Directors & Officers Liability Insurance (Side A) Renewal Application (.PDF file) Kidnap & Ransom/Extortion Application

Our goal at FGIB…in addition to providing you with the best coverage possible…is to simplify the insurance process as much as possible for you. For your convenience we have made the following applications, forms and documents available to you.

All of these are available for download in Microsoft Word (.DOC) or Adobe Acrobat (.PDF) Format. Please select the application that you require by clicking on the appropriate link. If you do not have Acrobat Reader and wish to install it, you can access it directly from the Adobe Web Site (www.adobe.com) at no charge.

After downloading the form, please print it, fill in all of the requested information and either Mail or Fax your completed application to FGIB. It’s our version of fast, simple and efficient.