Cyber Liability Insurance

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Insured Name *
Your Email *
Your Phone Number
Business Description *
Business Address *
Total Revenue * $ Dollars . Cents
Number of Employees (Full Time Equivalent) *
CYBER & PRIVACY LIABILITY COVERAGE
Do you have anti-virus software installed on all desktops, laptops and servers (excluding database servers) and it is updated on a regular basis? *

Do you have anti-virus software installed on all desktops, laptops and servers (excluding database servers) and it is updated on a regular basis? Yes No
Do you have firewalls installed on all external gateways? *

Do you have firewalls installed on all external gateways? Yes No
Do you take regular back-ups (at least weekly) of all critical data and store the same offsite or in a fire-proof safe, or your outsourced service provider meets this requirement? *

Do you take regular back-ups (at least weekly) of all critical data and store the same offsite or in a fire-proof safe, or your outsourced service provider meets this requirement? Yes No
Do you store medical records or patient data? *

Do you store medical records or patient data? Yes No
Do you ensure that all patient data transmitted over open networks and/or stored on portable devices is encrypted *

Do you ensure that all patient data transmitted over open networks and/or stored on portable devices is encrypted Yes No
Do you process or store credit card information? *

Do you process or store credit card information? Yes No
Are you certified as being PCI compliant within the last 12 months, or have successfully completed a self-assessment audit? *

Are you certified as being PCI compliant within the last 12 months, or have successfully completed a self-assessment audit? Yes No
CLAIMS INFORMATION
After full inquiry, are you aware of any circumstances, complaints, claims, loss , penalties or fines levied against you in the last five years? *

After full inquiry, are you aware of any circumstances, complaints, claims, loss , penalties or fines levied against you in the last five years? Yes No
Are you aware of any circumstances or complaints against you in relation to data protection or security, or any actual security violations or security breaches either currently or in the past five year? *

Are you aware of any circumstances or complaints against you in relation to data protection or security, or any actual security violations or security breaches either currently or in the past five year? Yes No
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Cyber Liability Insurance

Cyber Liability Insurance

CYBER & PRIVACY LIABILITY COVERAGE

CLAIMS INFORMATION

Disclaimer

Financial Services Guide