Transcription of BEAZLEY BREACH RESPONSE APPLICATION
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BEAZLEY BREACH RESPONSE APPLICATION
F00657112017 1 of 7 BEAZLEY BREACH RESPONSEAPPLICATIONNOTICE: THIS POLICY S LIABILITY INSURING AGREEMENTS PROVIDE COVERAGE ON A CLAIMS MADE ANDREPORTED BASIS AND APPLY ONLY TO CLAIMS FIRST MADE AGAINST THE INSURED DURING THE POLICYPERIOD OR THE OPTIONAL EXTENSION PERIOD (IF APPLICABLE) AND REPORTED TO THE UNDERWRITERS INACCORDANCE WITH THE TERMS THIS INCURRED AS CLAIMS EXPENSES UNDER THISPOLICY WILL REDUCE AND MAY EXHAUST THE LIMIT OF LIABILITY AND ARE SUBJECT TO READ THIS POLICY fully answer all questions and submit all requested INFORMATION:Full Name:Mailing Address:State of Incorporation:City:State & Zip:# of Employees:Date Established:Website URL s:Authorized Officer1:Telephone:E-mail: BREACH RESPONSE Contact2:Telephone:E-mail:Business Description:Does the Applicant provide data processing, storage or hosting services to third parties?
f00657 112017 ed. page 6 of 7 effective date of the insurance, the applicant will, in order for the information to be accurate on the effective date of the insurance, immediately notify the insurer of such
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