The American Federation of Teachers (AFT) requires that all state and local affiliates have Fidelity Bond Insurance to cover the potential loss of funds by officers, staff and members responsible for handling your organization’s money. If you have a separate entity established as a Benefit Plan or Trust, the insurance carrier requires AFT to submit and name those entities separately as another insured entity (Named Insured) in order to provide coverage. Please complete this form for both your local and your affiliated Benefit Plan or Trust, if applicable.The specific amount of fidelity bond coverage offered by the AFT is calculated based on guidelines from the U.S. Department of Labor as follows:(Total Liquid Assets + Total Receipts) x 10% = Required Amount of CoverageLiquid assets, for purposes of this formula, are those financial assets that are quickly and easily accessible. Cash on hand or deposits in any type of financial institution, certificates of deposit, and U.S. Treasury securities are common examples of liquid assets. Receipts include your annual membership dues plus any other form of regular income.Based on the above computation, please indicate your selections below and submit a copy of your most recent annual financial report to support the coverage amount selected. Please send your supporting documents to bondinfo@aft.org. Coverage limits become effective upon receipt of this form and required documentation by the insurer’s representative as submitted by AFT. Signature (required) Clear signature All fields are required. Type of Request (Choose One) * Certificate of Insurance Only Increase Amount Decrease Amount New Coverage (State or Local Affiliate) New Coverage (Benefit Plan or Trust) If you chose Certificate of Insurance Only above, please identify for which year(s). (NOTE: A Certificate of Insurance will be sent to the email address provided below.) 2024-2025 (March to March) 2023-2024 (March to March) Total coverage amount (Total Liquid Assets + Total Receipts) x 10% = Required Amount of Coverage) * $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 $450,000 $500,000 Full Name of Local or Legal Name of Trust * Local # * Your Name * Position * President Treasurer/Secretary-Treasurer Other Affiliate Officer Executive Director or designated alernate Your email or union email address * Preferred address is the union office, if no office, use your home. Street Address/P.O. Box * City * State * Zip Code * Phone # * Leave this field blank