Describe the Business

Organization Name

Enter Your Organization’s legally incorporated name.

Contact Name

Enter your name.

Contact Email

Please enter the work email of the contact person

Contact Phone

Enter your phone.

Organization website

Enter your company website

Address

Street Address

City

State

Postal code

Operations

Year Established *

Employee Count

How many individuals do You employ, including any natural person providing services at Your direction or in Your service?

Annual Revenue (Sales)

What was your total Annual Revenue as of the most recent fiscal/calendar year end?

Organization Type

Data Assets

Estimated Personal Records

Provide an estimate of the total number of protected personal information records for which You have liability (including but not limited to information You store, process, transact, collect, accept, handle, or transmit.

Payment Card Transactions

How many payment card transactions do you store?

Healthcare Information Transactions

How many healthcare records do you maintain, process or store?

Security Organization

Check all that apply

Patching Critical Software Procedures to regularly download and install patches for critical software

Business Continuity & Disaster Recovery Plans to respond to cyber incidents, with up to date & regularly tested procedures

Media Content Review for all media content disseminated online, including obtaining proper legal utilization rights of 3rd party created content and enforcing removal procedures thereof if applicable

Vendor Security Controls by validating vendor/supplier bank account additions and updates by a second means of communication and by contractually requiring standardized vendor security

Employee Training mandatory employee training on information privacy and social engineering, conducted at least annually?

Employee Training on Funds Transfer Protocol employee training on Funds Transfer Protocol best practices conducted at least anually?

Funds Transfer Controls to confirm and authenticate any wire or funds transfer request by a secondary means of communication prior to processing, and allowing only authorized employees to initiate the transfer

Security

Network Security

Check any that apply:

Network Firewalls or Security Group Settings (Cloud Environments)

Intrusion Detection Systems (or Prevention Systems)

Security Information & Event Monitoring (SIEM)

Endpoint Security

Do you deploy, monitor and maintain Antivirus or EDR solutions on any of the following:

Laptops/Computers

Servers

Networks

Mobile Devices

Vulnerability Management

Does your organization conduct regular or periodic penetration testing by a third party?

Yes

Check any that apply:

Network of Cloud Infrastructure Penetration Test

Web Application Penetration Test

Mobile Application Penetration Test

API Penetration Test

Secure Software Development Lifecycle (SDLC)

(If applicable) Does your organization conduct any of the following on a regular or periodic cadence?

Code Reviews

Static Code Analysis

Dynamic Code Analysis

Encryption

Do you encrypt all Personally Identifiable Information, Payment Information, Healthcare Information?

Yes

Do you encrypt the above information at rest and during transit from the following

Any computing devices (laptop/desktop)

Smartphones

Other portable media devices (tablets etc.)

Loss Information

In the past, have you:

(1) experienced any actual or attempted event, loss, or situation or been the subject of any civil, criminal, or regulatory claim, action, investigation, inquiry, or other legal action, which was directly or indirectly related to, or which would have fallen within the scope of, the cyber insurance for which you are applying; or

(2) been subject to any complaints concerning the content of Your website, advertising materials, social media, or other publications?

Yes

Are you aware of, or do you have any knowledge of information regarding, any fact, circumstance, situation, lawsuit, wrongful act, notice, event, incident, or transaction that could reasonably give rise to a cyber event, loss, obligation, or claim being against you which is expected to actually or potentially fall within the scope of the cyber insurance for which you are applying? *

Yes

Insurance Posture

Operations include Cannabis, Gambling or Adult Content

Organization operates as a Franchise

Revenue for current year is anticipated to be different that last years

You have an active technology errors & omissions or management professional liability policy concurrent with this insurance policy

Organization has controlled subsidiaries

Your Organization currently buys Cyber Insurance