Company Overview
What is your first name?
What is your last name?
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What is your full name?
What is your title?
What is your email address?
What is your phone number?
What is the legal name of the Company you are seeking cyber liability coverage for?
Please provide a brief description of the Company's business operations.
What is the Company's corporate entity type?
Please enter the Company's corporate entity type?
What date should the Cyber Liability coverage be effective?
MM slash DD slash YYYY
What is the Company's primary website address?
What is address of the Company's corporate headquarters?
What is the primary industry of the Company?
What year was the Company established? (YYYY)
How many total employees does the Company have?
Where does the company operate?
What was the Company's gross revenue for the prior fiscal year?
What percentage of the gross revenue was generated online in the prior fiscal year? (Ex. 50%)
What was the Company's gross revenue for the prior fiscal year in the United States?
What percentage of the U.S. gross revenue was generated online in the prior fiscal year?
What was the Company's gross revenue for the prior fiscal year outside the United States?
What percentage of the foreign gross revenue was generated online in the prior fiscal year?
Information Privacy & Governance
Which of the following types of Privacy Information (Personal Information or Third Party Corporate Information) does the Company store, process, transmit or otherwise have responsibility for securing? (Select all that apply)
How many government issued identification numbers (e.g. social security numbers) does the Company store?
Please enter the number of government issued identification numbers (e.g. social security numbers) the Company stores?
How many credit card numbers, debit card numbers or other financial account numbers does the Company store?
Please enter the number of credit card numbers, debit card numbers or other financial account numbers the Company stores?
How many healthcare or medical records does the Company store?
Please enter the number of healthcare or medical records the Company stores?
How many intellectual property (e.g. third party intellectual property trade secrets, M&A information) records does the Company store?
Please enter the number of intellectual property (e.g. third party intellectual property trade secrets, M&A information) records the Company stores?
How many usernames and passwords does the Company store?
Please enter the number of usernames and passwords the Company stores?
Encryption
Which of the following statements are valid as it relates to Privacy Information governance?
Does the Company encrypt private information when transmitted over public networks (e.g. the Internet)?
Does the Company encrypt private information when stored on mobile assets (e.g. laptops, phones, tablets, flash drives)?
Does the Company encrypt private information when stored on enterprise assets (e.g. databases, file shares, backups)?
Does the Company encrypt private information when stored with third party services (e.g. cloud provider)?
Does the Company store private information on a secure network zone that is segmented from the internal network?
Information Security Organization
Is the Company compliant with any of the following regulatory or compliance frameworks (please check all that apply and indicate most recent date of compliance):
What date did the Company become compliant with ISO1799? (DD/MM/YYYY)
What date did the Company become compliant with SOX? (DD/MM/YYYY)
What date did the Company become compliant with PCI-DDS? (DD/MM/YYYY)
What date did the Company become compliant with HITECH? (DD/MM/YYYY)
What date did the Company become compliant with HIPAA? (DD/MM/YYYY)
What date did the Company become compliant with GLBA? (DD/MM/YYYY)
What date did the Company become compliant with SSAE-16? (DD/MM/YYYY)
What date did the Company become compliant with FISMA? (DD/MM/YYYY)
What is the name of the other regulatory or compliance framework the Company is compliant with and what date did the Company become compliant with it? (DD/MM/YYYY)
Information Security
Does the Company have a formal risk assessment process that identifies critical assets, threats and vulnerabilities?
Does the Company have a disaster recovery and business continuity plan?
Does the Company have an incident response plan for determining the severity of a potential data security breach and providing prompt notification to all individuals who may be adversely affected by such exposure?
Does the Company have an intrusion detection solution that detects and alerts an individual or group responsible for reviewing malicious activity on the Company's network?
Does the Company configure firewalls to restrict inbound and outbound network traffic to prevent unauthorized access to internal networks?
Does the Company install and update an anti-malware solution on all systems commonly affected by malicious software (particularly personal computers and servers)?
Does the Company update (e.g. patch, upgrade) commercial software for known security vulnerabilities per the manufacturer’s advice?
Does the Company update open source software (e.g. Java, Linux, PHP, Python, OpenSSL) that is not commercially supported for known security vulnerabilities?
Documents and Comments
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Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.
Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.
