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Core Shield Pro
General Applicant Information (applies to all coverages)
Applicant Name
Contact Name and Title
*
Contact Phone Number
*
Contact Email Address
*
Company Website / Domains
*
Physical Address
*
*
*
*
*
Year Incorporated / Estabilished
*
Company Type
*
Company Type
Privately Held
Publicly Traded
Not-for-Profit
Financial Institution
Other
Nature of Operations / Entity Type
*
Total Number of Employees (Full-time, Part-time, Contractors)
*
How many Board of Directors does the Applicant have?
*
How many independent directors serve on the board?
*
Any Board changes in the last 12 months?
*
If Yes, please provide details
Any Board changes in the last 12 months?
Yes
No
Any planned layoffs or subsidiary closures?
*
If Yes, please provide details
Any planned layoffs or subsidiary closures?
Yes
No
Other Locations (beyond HQ address)?
*
If Yes, please list all locations and addresses
Other Locations (beyond HQ address)?
Yes
No
Has the Applicant been involved with, negotiated, attempted or transacted any merger, acquisition, asset sale or divestment in the past 18 months involving more than 25% of total assets or securities?
*
If Yes, please provide details
Has the Applicant been involved with, negotiated, attempted or transacted any merger, acquisition, asset sale or divestment in the past 18 months involving more than 25% of total assets or securities?
Yes
No
Date of latest capital raise
*
Valuation of latest capital raise
*
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