APPLICATION FORM - Cyber, Data and Policy

Notice: The policy for which these questions are made is a claims made and reported policy subject to its terms. The questions contained herewith pertain to all persons or entities seeking insurance, and not just the signatory.

Company Details



Select your preferred Cyberboxx Option

Please read these questions carefully. You must provide us with accurate and complete information. Failure to do so may affect the validity of the policy or whether the policy responds to any claim in full or at all.

Security controls:

For Cyber Deception optional coverage (only):

Important -

By entering your name and email, you agree that all information provided to BOXX Insurance to generate this insurance policy is accurate and true.  Entering your name and email address is akin to signing any legal document and you will be bound to all acknowledgements provided herein and that you have the authority to bind your company to this agreement.

Thanks for submitting!