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Core Shield Solution Indication Form

Company/Entity Name

*

Contact Name

*

Contact Email Address

*

WhatsApp Phone Number

*

Telegram Handle

Country

*

Select Entity Type

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Private company (pre-IPO)

L1/L2 protocol foundation

Exchange and liquidity platform

CeFi and DeFi entity, including DeFi Protocol

Crypto Service Provider - Custodian/Custody Provider, OTC desk, Asset Manager, Investment Advisor, Broker Dealer, and Fund/VC fund

Fintech, payment processor, and technology service provider

Blockchain infrastructure

Select Limit

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$100K

$250K

$500K

$1M

Select Coverage

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D&O

E&O/Professional Indemnity

Crime/Specie

Select shared limits (one policy limit applies to all coverages) or separate limits (a policy limit for each coverage selected)

*

Shared Limits

Separate Limits

D&O: $ - $ E&O: $ - $ CSP: $ - $ Total Premium Range: $ - $

The premium shown is an estimate based on the information provided. Final premium, coverage terms, and conditions are subject to review and confirmation by the insurer following completion of the full application and underwriting process.