Complete the lost bond redemption request form and affidavit of loss. Download the request form and affidavit.Print a copy of this form 3. Complete all information 4. Notices are to be sent to the following address: Philadelphia Insurance Companies Attn: Surety Claims PO Box 3636 Bala Cynwyd, PA 19004 SURETY BOND - SAMPLE FORM. Bond Issuing Company: Bond Number: We,. To submit this bond refund form, you can choose between online submission or mailing it to GPO Box 965, ADELAIDE SA 5001.