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Cyber Liability Insurance Premium Indication
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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Contact Name
*
First
Last
Contact Email Address
*
Enter Email
Confirm Email
Industry
*
SELECT
Car Dealership
Charities / Not for Profit
Construction
Domestic Services (e.g. plumbers, electricians, tree surgeons, gardeners, cleaners)
Education (colleges/universities)
E-commerce
Fin.Inst - Community / State / Credit Union
Fin.Inst - National
Gas Station
Golf Clubs
Government
Healthcare / Medical
Hotels / Hospitality
Insurance Broker / Company (commercial)
Insurance Broker / Company (personal lines)
Investment Advisor / CPA / Mortgage Broker
Legal Svcs (commercial)
Legal Svcs (consumer)
Manufacturing
Pharmacy
Professional Svcs excl Legal Svcs
Realtor
Restaurant
Retail
Sports clubs/gyms
Telecoms
Trade Associations / Unions
Utility
Veterinarian
Wholesale Distributor
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
*
SELECT
$1,000,000
$2,000,000
$3,000,000
$5,000,000
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