Cyber Insurance Quotes

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Named Insured

Your company name

Website

Company Domain Name(s)

Address

Street Address City State / Province / Region ZIP / Postal Code

Email

Industry

Number of Employees

Expected Revenue

Over next 12 months

Gross Profit/Net Revenue

Expected over next 12 months

Attestation Questions

Within the last 3 years, has the Named Insured suffered any cyber incidents resulting in a claim in excess of $25,000?

No
Yes

If yes, please explain the cyber incidents and/or claims.

Documentation can be attached via the "File Upload" box at the bottom of this page.

Is the Named Insured aware of any circumstances that could give rise to a claim under this insurance policy?

No
Yes

If yes, please explain the circumstances and/or potential claims.

Documentation can be attached via the "File Upload" box at the bottom of this page.

Does the Named Insured enable disk encryption on laptops, desktops, and other portable media devices?

No
Yes
Sometimes

Does the Named Insured accept credit cards or collect Personally Identifiable Information (PII) or Protected Health Information (PHI) from its customers?

This does not include employees of the Named Insured.

No
Yes

How many payment card numbers (credit card, debit card, etc) does the Named Insured store, process, transmit, or have access to?

This does not include employees of the Named Insured.

None
Less than 100,000
100,000-500,000
500,000-1,000,000
Over 1,000,000

How many customer PII or PHI Records does the Named Insured have?

None
Less than 100,000
100,000-500,000
500,000-1,000,000
Over 1,000,000

Does the Named Insured have procedures to back up, archive, and restore sensitive data and critical business systems?

No
Yes

Does the Named Insured require dual control when transferring funds in excess of $25,000?

*Dual control for transferring funds refers to a process by which a transfer must be approved or confirmed by someone other than the initiator of the transfer.

No
Yes

Within the last 3 years, has the Named Insured been subject to any complaints concerning the content of its website, advertising materials, social media, or other publications?

No
Yes

Does the Named Insured have procedures to remove content (including third-party content) that is libelous, infringing, or otherwise controversial?

No
Yes

File Upload

Upload any documents you wish to send us regarding claims or bar complaints.

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Cyber Insurance - Quote Form

Attestation Questions

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