Follow the steps to successfully complete the form

1. Click the ‘Get Form’ button to access the MESA Underwriters Terrorism Form and open it for editing.
2. Carefully read the important information and policyholder disclosure section regarding coverage for acts of terrorism. This section outlines your rights under the Terrorism Risk Insurance Act and the conditions of the insurance coverage.
3. In the section that requires you to select either to accept or reject the terrorism insurance coverage, choose one of the options by marking the appropriate box.
4. If you select to accept coverage, enter the premium amount in the designated field, including any applicable taxes, and specify the effective dates for the coverage period.
5. If you reject the coverage, simply acknowledge your understanding that losses arising from unapproved acts of terrorism will not be covered.
6. Fill out the required fields for the policyholder/applicant name, signature, title, policy number, and date. Ensure all information is accurate and legible.
7. Once all sections are completed, make sure to save the changes to the form. You may also download, print, or share the form as needed.

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