MESA Underwriters Terrorism Form - Cox Specialty Markets 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by reviewing the important information section, which outlines your rights under the Terrorism Risk Insurance Act of 2002. This will help you understand the implications of purchasing or rejecting coverage.
3. In the 'Please select one of the following' section, choose whether to accept or reject terrorism insurance coverage by clicking on the appropriate option.
4. If you elect to purchase coverage, fill in the premium amount and applicable tax in the designated fields. Specify the coverage period by entering start and end dates.
5. Type or print your name as the Policyholder/Applicant in the provided field, followed by your signature and title.
6. Enter your policy number and date in their respective fields to complete the form.
7. Once completed, save your document and return it through your agent. Remember to keep a copy for your records.

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