Apply for the Global Insurance Accelerator's 2019 Cohort

The application deadline is Thursday November 1st at 11:59PM EST
All fields are required. In case you missed it, program details are available here and program schedule here.

Let's start with your company.

Company Name:

Company website:

Home state/province and country:

Year founded:

What do you tell people you do?

Elevator pitch, high level. 250 characters max.

Next, tell us about your customer and product.

Describe your prospective customer(s):

If you have a complex sale, spell it out. If you are selling indirectly to insurance, explain. 1500 characters max.

Do you have paying customers today? (paid pilots count)

What stage is the product in (concept, in-development, piloted, active customers, other)?

What does/will the product do?

Feel free to geek out. We speak all sorts of tech on this end. 2500 characters max.

A few more details.

What is your business model?

How do you make money? 1500 characters max.

Who are your competitors?

+1 if you provide URL's and explain why you are different.

If you have raised capital from non-founders, how much?

Tell us about the team

Please list all shareholders and other critical team members. One per line, include: first/last name, role, LinkedIn URL
For example: Edmund Halley, Lead Developer, http://(LinkedIn URL)

Who is the point of contact for this application?

First name:
Last name:
LinkedIn URL:

What do you want to accomplish while at the accelerator?

What are the key milestones the GIA can help you achieve?

Any conflicts we need to consider?

Please use this field to communicate anything that may keep you from fully participating; for example:
- if you have signed, or plan to sign, legally binding documents from other accelerators which limit your ability to accept an invitation to the GIA's program
- limitations you may have for the the residency requirement