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Crypto Shield Pro for Unchained
Underwriting Application
Email
*
Named Insured
*
Website Domain(s)
*
Physical Address
(Street, City, State or Country, Zip)
*
Please indicate entity type:
(i.e. Asset management, law firm, e-commerce)
*
Please indicate entity type: (i.e. Asset management, law firm, e-commerce)
A
Individual
B
Asset Manager
C
Private Enterprise, including Start-up enterprises Law Firm
D
Accounting Firm
E
E-Commerce
F
Insurance
G
Media/Tech
H
Crypto Technology Company
I
Other
Year Established
*
In USD
Current Year Revenue
*
Future 12 months Revenue
*
Assets Under Custody
*
Assets Under Custody
A
under $25,000,000
B
$25,000,000 - $75,000,000
C
$75,000,000 - $150,000,000
D
over $150,000,000
E
Other
What percentage of Assets Under Custody do you desire to have insured?
*
What percentage of Assets Under Custody do you desire to have insured?
A
1-10%
B
10-25%
C
25-50%
D
more than 50%
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