Cyber Liability Insurance Premium Indication

INSURED

Complete this short application to get a cyber liability insurance quote. Please note that the following industries are excluded: Social Media, Adult Content, Technology Companies, Payment Processors, Business Process Outsourcing, Debt Collecting.

Company Name*

Corporate Principal Address*

Street Address City State ZIP Code

Contact Name*

First Last

Contact Email Address*

Enter Email Confirm Email

Industry*

Gross revenue*

RISK AND CLAIMS

Do you, or an outsourced firm, back up your data and systems at least once a week, and store these backups in an offsite location?*

Yes
No

Do you have antivirus and firewalls in place and that these are regularly updated (at least quarterly)?*

i.e. answer "Yes" if you have an antivirus system, for example McAfee, Norton Antivirus or AVG, etc. that are protecting your computers

Yes
No

Underwriters will not offer coverage for an applicant without antivirus or firewalls in place.

Are you aware of any or have any grounds for suspecting any circumstances which might give rise to a claim?*

Yes
No

Potential Claims Details

Within the last 5 years, has your company suffered any system intrusions, tampering, virus or malicious code attacks, loss of data, loss of portable media, hacking incidents, extortion attempts, or data theft, resulting in a claim in excess of $25,000 that would be covered by this insurance?*

Yes
No

Coverage details

Limit of liability*

Cyber Deception Coverage Extension

For an additional $450 premium, the Cyber Deception extension provides coverage for the intentional misleading of the Applicant by means of a dishonest misrepresentation of a material fact contained or conveyed within an electronic or telephonic communication(s) and which is relied upon by the Applicant believing it to be genuine.This is commonly known as "spear-phishing" or "social engineering". Please note that the Cyber Deception Coverage ONLY applies to Money or Goods of the Insured and will NOT apply to Money or Goods of a Third Party (Customer) held in their Care Custody and Control and released to others.

Would you like to add the Optional Cyber Deception Coverage Extension (for an additional premium) to your quote?*

Yes
No

Does the Applicant have dual control when transferring funds in excess of $25,000 to external parties?*

Yes
No

STOP

Please note the applicant is not eligible for Cyber Deception coverage at this time.

Does the Applicant provide training for staff members who transact funds in excess of $25,000 externally?*

Yes
No

STOP

Please note the applicant is not eligible for Cyber Deception coverage at this time.

Have there been any losses for a Cyber Deception Event in the past year in excess of $10,000?*

Yes
No

Please provide details on Cyber Deception