Form SF 28 SF 28 Affidavit of Individual Surety

Affidavit Of Individual Surety
(See instructions on page 4)
State Of

County Of

OMB Control Number: 9000-0001
Expiration Date: 3/31/2024
ss.

I, the undersigned, being duly sworn, depose and say that I am: (1) the surety to the attached bond(s); (2)
a citizen of the United States; and of full age and legally competent. Where the sureties are acting as cosureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for
the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each
Surety binds itself, jointly and severally with the Principal. I recognize that statements contained herein
concern a matter within the jurisdiction of an agency of the United States and the making of a false,
fictitious or fraudulent statement may render the maker subject to prosecution under Title 18, United States
Code Sections 1001 and 494. This affidavit is made to induce the United States of America to accept me
as surety on the attached bond.
1. Name (First, Middle, Last) (Type or Print)

2A. Home Address (Number, Street, City, State, ZIP
Code)

3. Type And Duration Of Occupation
2B. Telephone Number 2C. Email Address
4A. Name And Address Of Employer (Number,
Street, City, State, ZIP Code) (If selfemployed, so state)

5A. Name And Address Of Individual Surety Broker
Used (Number, Street, City, State, ZIP Code)

5B. Surety Broker Email Address
4B. Employer Email Address

5C. Home Telephone
Number

5D. Business Telephone
Number

6A. Name And Address Of Financial Institution
6B. Financial Institution 6C. Routing Transit
Number (RTN)
Submitting The Pledge Of Securities On Behalf
Email Address
Of Individual Surety (Number, Street, City,
State, ZIP Code)
6E. Contact Person
6D. Contact Person
Telephone Number
Name
6F. Contact Person Email Address
Authorized For Local Reproduction
Previous Edition Is Not Usable

STANDARD FORM 28 (REV. 10/2023)
Prescribed by GSA-FAR (48 CFR) 53.228(e)

7. The Following Is A True Representation Of The Assets I Have Pledged To The United States In
Support Of The Attached Bond. (List The Committee On Uniform Securities Identification Procedures
(CUSIP) Number And Par (Face) Amount Of Each Security).

8. Identify All Liens, Judgements, Or Any Other Encumbrances Involving Subject Assets.

STANDARD FORM 28 (REV. 10/2023) PAGE 2

9. Identify All Bonds, Including Bid Guarantees, For Which The Subject Assets Have Been Pledged Within
Three Years Prior To The Date Of Execution Of This Affidavit.

Documentation Of The Pledged Asset Must Be Attached.
11. Bond And Contract To Which This Affidavit Relates (where
appropriate)

10. Signature

12. Subscribed And Sworn To Before Me As Follows:
a. Date Oath Administered
Month

Day

b. City And State (or other jurisdiction)
Year

d. Signature
c. Name And Title Of Official
Administering Oath (type or print)

e. My Commission
Expires

Official
Seal

STANDARD FORM 28 (REV. 10/2023) PAGE 3

Instructions
1. Individual sureties on bonds executed in connection with Government contracts must complete
and submit this form with the bond. (See Federal Acquisition Regulation (FAR) 28.203, 53.228(e).)
The surety must have the completed form notarized.
2. No corporation, partnership, or other unincorporated association or firm, as such, is acceptable as an
individual surety (i.e. must be a natural person). Likewise, members of a partnership are not
acceptable as sureties on bonds that a partnership or an association, or any co-partner or member
thereof, is the principal obligor. An individual surety will not include any financial interest in assets
connected with the principal on the bond that this affidavit supports.
3. United States citizenship is a requirement for individual sureties for contracts and bonds when the
contract is awarded in the United States. However, when the Contracting Officer is located in an
outlying area or a foreign country, the individual surety is only required to be a permanent resident of
the area or country in which the contracting officer is located.
4. All signatures of the affidavit submitted must be originals. Affidavits bearing reproduced signatures
are not acceptable. An authorized person must sign the bond. Any person signing in a representative
capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a
member of a firm, partnership, or joint venture, or an officer of the corporation involved.

Paperwork Reduction Act Statement
This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the
Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid
Office of Management and Budget (OMB) control number. The OMB control number for this collection is
9000-0001. We estimate that it will take 0.3 hours to read the instructions, gather the facts, and answer the
questions. Send only comments relating to our time estimate, including suggestions for reducing this
burden, or any other aspects of this collection of information to: U.S. General Services Administration,
Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

STANDARD FORM 28 (REV. 10/2023) PAGE 4