STATE OF GEORGIA DEPARTMENT OF LABOR
148 Andrew Young International Blvd., N.E., Suite 826
Atlanta, Georgia 30303-1751
Phone: (404) 232-3310
EMPLOYEE LEASING COMPANY’S STATUTORY SURETY BOND
Georgia DOL Account No.
Surety Bond No.
STATE OF GEORGIA COUNTY
KNOW ALL MEN BY THESE PRESENTS, That,
an employer subject to the provisions of OCGA Sections 34-8-32, 34-8-33, 34-8-34 and 34-8-172 of the Employment
Security Law, and having its principal place of business at
as principal, and ,
a surety corporation authorized by law to transact business in the State of Georgia, as surety, pursuant to the afore-
said law and in compliance therewith, are hereby held and ﬁrmly bound unto the Commissioner of Labor of the State
of Georgia, and his successors in ofﬁce, and unto the State of Georgia, Department of Labor, upon the conditions,
hereinafter set forth, in the full sum of
($ ), for the payment of which well and truly to be made we bind ourselves, our heirs, administrators,
executors, successors and assigns jointly and severally, ﬁrmly by these presents.
Signed, sealed and delivered this day of , 20
THE CONDITIONS OF THE FOREGOING OBLIGATION are such that the above named prinicpal has been
duly registered as an employer under the Employment Security Law subject to the provisions of the said Employment
NOW THEREFORE, should the said prinicpal well and truly ﬁle all reports and otherwise timely fulﬁll and
comply with all requirements and regulations set forth in said Employment Security Law and pay all contributions
due and to become due under said law, and penalties and interest assessed pursuant to said law for the
to then this obligation to be void, otherwise, of full force and effect.
IN WITNESS WHEREOF, the said principal and surety have executed this instrument under their hands and
seals, including the corporate seals, this day of , 20
APPROVED AS TO AMOUNT, FORM AND
GEORGIA DEPARTMENT OF LABOR
NOTE: The ofﬁcial or attorney in fact signing for Surety shall attach to the original bond a certiﬁed copy of authority or
power to bind the Surety. It shall show that the power is in force and effect at the time of the execution of the bond.