Cyber Insurance
Cyber Security
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Cyber Insurance Quotes

1 1. Basic Information

2 2. Data

3 3. Security Controls

4 4. Additional Information

5 5. Final Step

Basic Information
Fill out this application and get real Cyber Insurance quotes from the A+ rated carriers. This simple process will take less than 5 minutes.
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Geocoder
First Name*
Last Name*
Email Address*
Phone Number*
Company Name*
Company Website
Industry type*

Desktop Computers - Are designed for regular use at a single location.
Mobile Devices - Are designed for mobility and could be easily transported.
Examples: Laptops, Tablets, Smartphones, etc...
Removable Media - Removable storage devices that are used to transport or store data.
Examples: USB flash drives, External hard disk drives, magnetic tapes, optical disks, etc...
Cloud Storage - is a new form of Internet-based storage.
Examples: DropBox, Box, Microsoft OneDrive, etc...
Projected total annual revenue for the next 12 months*
Company Address*
Suite, Unit, Building, or Floor
Street
City
State
Zip Code
Indicate the number of employees presently employed by your company*
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Data
What types of sensitive data does {Single Line Text:48} utilize?

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Does accept customer information?*
- Yes
- No
Personally Identifiable Information (PII) - is any information that can be used to identify a specific individual.
Examples: Name, Birthdate, or Address.
Sensitive Personal Information (SPI) - is any information that can be used to identify a specific individual and could result in substantial harm, embarrassment, inconvenience, or unfairness.
Examples: Social Security number, Passport number, Alien registration number, Biometric identifier, Driver's license number, Citizenship or immigration status, Tax information.
Indicate approximately how many unique customer records does or a third party on behalf of accept, store or transmit per year*
Personally Identifiable Information (PII) - is any information that can be used to identify a specific individual.
Examples: Name, Birthdate, or Address.
Sensitive Personal Information (SPI) - is any information that can be used to identify a specific individual and could result in substantial harm, embarrassment, inconvenience, or unfairness.
Examples: Social Security number, Passport number, Alien registration number, Biometric identifier, Driver's license number, Citizenship or immigration status, Tax information.
Does accept credit cards?*
- Yes
- No
Payment Cards - sensitive data from any of the card types.
Examples: Credit Card, Debit Card, Charge Card, ATM Cards, Stored-value Card, Fleet Card, Gift Card
Indicate approximately how many unique credit cards does or a third party on behalf of accept, store or transmit per year*
Merchant Level 1 - Merchants processing more than 6,000,000 transactions per year.
Merchant Level 2 - Merchants processing 1 million – 6 million transactions annually.
Merchant Level 3 - Merchants processing 20,000 to 1 million transactions annually.
Merchant Level 4 - Merchants processing less than 20,000 transactions annually.
Is currently compliant with Payment Card Industry Data Security Standard (PCI DSS)?*
- Yes
- No
The Payment Card Industry Data Security Standard (PCI DSS) is a set of security standards designed to ensure that ALL companies that accept, process, store or transmit credit card information maintain a secure environment.
Please explain:*
Does accept patient healthcare information?*
- Yes
- No
Protected Health Information (PHI) - any medical information that can be linked to a specific individual.
Is currently compliant with HIPAA Privacy, Security and Breach notice rules?*
- Yes
- No
HIPAA (Health Insurance Portability and Accountability Act) Is United States legislation that provides data privacy and security provisions for safeguarding medical information.
Please explain:*
Does utilize portable devices to store sensitive information?*
- Yes
- No
A portable device such as laptops, smartphones, tablets, external hard drive, backup tapes, USB drives.
Is the sensitive information stored on portable devices encrypted?*
- Yes
- No
Encryption is a method of disguising the information in a way that only authorized parties can view it.
Does utilize a cloud provider to store sensitive information?*
- Yes
- No
Cloud service providers (CSP) are companies that offer network, infrastructure, and applications that available for access via the Internet.
Examples: Microsoft Office 365, Google Docs, Gmail, Dropbox, etc...
Please name the cloud provider:*
If {Single Line Text:48} utilizes more than one cloud provider to store sensitive information, please name the cloud provider storing the largest quantity of sensitive records.
Does comply with local, state, federal and international security and privacy laws?*
- Yes
- No
Please explain:*
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Security Controls
What is the maturity level of {Single Line Text:48}'s cyber security program?

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Select which of the following options describes 's cyber security capabilities:*
- Basic
- Moderate
- Advanced
Which of the following cyber security controls does utilize?*
- Perimeter Firewalls
- Anti-virus & Anti-malware
- Strong Passwords
- Regular Patching
- No End-of-Life Hardware or Software
- Regular User Management
- Physical Security
- Incident Response Plan
- Encryption
- Backups
- Security Awareness Training
- Business Continuity Plan
- Disaster Recovery Plan
- Intrusion Detection/Prevention System (IDS/IPS)
- Regular Vulnerability Scanning
- Penetration Testing
- Security Policies & Procedures
- Data Classification Policy
- Data Loss Prevention (DLP) Tools
- Security Information & Event Management (SIEM)
Perimeter Firewalls - A network security device that monitors and controls the incoming and outgoing network traffic.
Anti-virus & Anti-malware -Software that is used to prevent, detect and remove malicious programs .
Strong Passwords - Designed to enhance computer security by requiring users to create strong passwords that are at least 7 characters and contain both numeric and alphanumeric characters. It is imperative that passwords are changed and upgraded frequently to ensure continued security.
Regular Patching -Deployment of regular software & firmware updates, patches, hotfixes or services packs to fix security vulnerabilities and other bugs.
No End-of-Life Hardware or Software - An E nd-of -L ife (EOL) product is a product that does not receive continued support from its parent. This can be due to existing marketing, support and other processes being terminated by the parent or the product is intentionally designed with an end-of-life protocol.
Regular User Management - Such as the immediate revocation of access after termination of employment; regular review of access and revocation for those users who no longer require it.
Physical Security - Security measures that are designed to deny unauthorized access to facilities, equipment, and resources, like for the immediate security of personnel and any property damage or harm.

Incident Response Plan - Documented instructions and procedures to detect, respond to, and limit consequences of a cyber attack.
Encryption - Encryption of stored sensitive data on mobile devices, removable media, backup media and cloud storage.
Backups - Backup of critical data to offline storage or media.
Security Awareness Training - Educating employees on the importance of computer security.
Business Continuity Plan - A document that defines prevention and recovery from potential threats to the business.
Disaster Recovery Plan - Documented process es or a set of procedures in case of a damaging cyber event to recover and protect a business IT infrastructure .
Intrusion Detection/Prevention System (IDS/IPS) - Network security software or appliances that monitor network or system activities for malicious activity.
Regular Vulnerability Scanning - Practice of identifying, classifying, remediating, and mitigating vulnerabilities scheduled to be performed on a regular basis.
Penetration Testing -A n a uthorized simulated attack on a computer system, performed to evaluate the security of the system.
Security Policies & Procedures - A document that outlines how a company plans to protect the company's physical and information technology assets.
Data Classification Policy - A policy that outlines the process of organizing data into defined categories.
Data Loss prevention Tools (DLP) - Network security software or appliances that detect potential data breaches or data ex-filtration transmissions.
Security Information & Event Management (SIEM) - Real-time analysis of security alerts generated by network hardware and applications.
Which of the following cyber security controls does utilize?*
- Perimeter Firewalls
- Anti-virus & Anti-malware
- Strong Passwords
- Regular Patching
- No End-of-Life Hardware or Software
- Regular User Management
- Physical Security
- Incident Response Plan
- Encryption
- Backups
- Security Awareness Training
- Business Continuity Plan
- Disaster Recovery Plan
- Intrusion Detection/Prevention System (IDS/IPS)
- Regular Vulnerability Scanning
- Penetration Testing
- Security Policies & Procedures
- Data Classification Policy
- Data Loss Prevention (DLP) Tools
- Security Information & Event Management (SIEM)
Perimeter Firewalls - A network security device that monitors and controls the incoming and outgoing network traffic.
Anti-virus & Anti-malware -Software that is used to prevent, detect and remove malicious programs .
Strong Passwords - Designed to enhance computer security by requiring users to create strong passwords that are at least 7 characters and contain both numeric and alphanumeric characters. It is imperative that passwords are changed and upgraded frequently to ensure continued security.
Regular Patching -Deployment of regular software & firmware updates, patches, hotfixes or services packs to fix security vulnerabilities and other bugs.
No End-of-Life Hardware or Software - An E nd-of -L ife (EOL) product is a product that does not receive continued support from its parent. This can be due to existing marketing, support and other processes being terminated by the parent or the product is intentionally designed with an end-of-life protocol.
Regular User Management - Such as the immediate revocation of access after termination of employment; regular review of access and revocation for those users who no longer require it.
Physical Security - Security measures that are designed to deny unauthorized access to facilities, equipment, and resources, like for the immediate security of personnel and any property damage or harm.

Incident Response Plan - Documented instructions and procedures to detect, respond to, and limit consequences of a cyber attack.
Data Encryption - Encryption of stored sensitive data on mobile devices, removable media, backup media and cloud storage.
Regular Data Backups - Backup of critical data to offline storage or media.
Security Awareness Training - Educating employees on the importance of computer security.
Business Continuity Plan - A document that defines prevention and recovery from potential threats to the business.
Disaster Recovery Plan - Documented process es or a set of procedures in case of a damaging cyber event to recover and protect a business IT infrastructure .
Intrusion Detection/Prevention System (IDS/IPS) - Network security software or appliances that monitor network or system activities for malicious activity.
Regular Vulnerability Scanning - Practice of identifying, classifying, remediating, and mitigating vulnerabilities scheduled to be performed on a regular basis.
Penetration Testing -A n a uthorized simulated attack on a computer system, performed to evaluate the security of the system.
Security Policies & Procedures - A document that outlines how a company plans to protect the company's physical and information technology assets.
Data Classification Policy - A policy that outlines the process of organizing data into defined categories.
Data Loss prevention Tools (DLP) - Network security software or appliances that detect potential data breaches or data ex-filtration transmissions.
Security Information & Event Management (SIEM) - Real-time analysis of security alerts generated by network hardware and applications.
Which of the following cyber security controls does utilize?*
- Perimeter Firewalls
- Anti-virus & Anti-malware
- Strong Passwords
- Regular Patching
- No End-of-Life Hardware or Software
- Regular User Management
- Physical Security
- Incident Response Plan
- Encryption
- Backups
- Security Awareness Training
- Business Continuity Plan
- Disaster Recovery Plan
- Intrusion Detection/Prevention System (IDS/IPS)
- Regular Vulnerability Scanning
- Penetration Testing
- Security Policies & Procedures
- Data Classification Policy
- Data Loss Prevention (DLP) Tools
- Security Information & Event Management (SIEM)
Perimeter Firewalls - A network security device that monitors and controls the incoming and outgoing network traffic.
Anti-virus & Anti-malware -Software that is used to prevent, detect and remove malicious programs .
Strong Passwords - Designed to enhance computer security by requiring users to create strong passwords that are at least 7 characters and contain both numeric and alphanumeric characters. It is imperative that passwords are changed and upgraded frequently to ensure continued security.
Regular Patching -Deployment of regular software & firmware updates, patches, hotfixes or services packs to fix security vulnerabilities and other bugs.
No End-of-Life Hardware or Software - An E nd-of -L ife (EOL) product is a product that does not receive continued support from its parent. This can be due to existing marketing, support and other processes being terminated by the parent or the product is intentionally designed with an end-of-life protocol.
Regular User Management - Such as the immediate revocation of access after termination of employment; regular review of access and revocation for those users who no longer require it.
Physical Security - Security measures that are designed to deny unauthorized access to facilities, equipment, and resources, like for the immediate security of personnel and any property damage or harm.

Incident Response Plan - Documented instructions and procedures to detect, respond to, and limit consequences of a cyber attack.
Data Encryption - Encryption of stored sensitive data on mobile devices, removable media, backup media and cloud storage.
Regular Data Backups - Backup of critical data to offline storage or media.
Security Awareness Training - Educating employees on the importance of computer security.
Business Continuity Plan - A document that defines prevention and recovery from potential threats to the business.
Disaster Recovery Plan - Documented process es or a set of procedures in case of a damaging cyber event to recover and protect a business IT infrastructure .
Intrusion Detection/Prevention System (IDS/IPS) - Network security software or appliances that monitor network or system activities for malicious activity.
Regular Vulnerability Scanning - Practice of identifying, classifying, remediating, and mitigating vulnerabilities scheduled to be performed on a regular basis.
Penetration Testing -A n a uthorized simulated attack on a computer system, performed to evaluate the security of the system.
Security Policies & Procedures - A document that outlines how a company plans to protect the company's physical and information technology assets.
Data Classification Policy - A policy that outlines the process of organizing data into defined categories.
Data Loss prevention Tools (DLP) - Network security software or appliances that detect potential data breaches or data ex-filtration transmissions.
Security Information & Event Management (SIEM) - Real-time analysis of security alerts generated by network hardware and applications.
<div class="modal-body">
<p style="text-align: center;"><i class="fa fa-lock"></i> Your data is safe with us.</p>
</div>

Additional Information
We are almost done-just a few more questions to go!

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Has had any actual or potential claims, litigation, or losses during the past 3 years arising from information security, network security, or media activities?*
- Yes
- No
Please explain:*
Is or any person proposed for this insurance aware of any fact, circumstance, situation, event or transaction which could reasonably be expected to give rise to any claim or loss that would fall within the scope of proposed coverage?*
- Yes
- No
I, {:17} {:159} understand and agree that if any fact, circumstance, situation, event or transaction exists, whether or not disclosed, the proposed insurance will not afford coverage for any claim or loss arising from such fact, circumstance, situation, event or transaction.
Please explain:*
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Final Step
Please review your answers, read the disclamer, sign and submit.

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Quote
Upon completion of the application, CyberDot will provide you with cyber liability quotes of $500,000 and $1,000,000. Would you require a quote for a different amount?*
- Yes
- No
Indicate a different amount:*
Basic Information
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Security Controls
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Additional Information
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Applicant Representations and Fraud Warnings
*
THE SIGNING OF THIS APPLICATION DOES NOT BIND THE INSURER TO OFFER, NOR THE APPLICANT TO PURCHASE, THE INSURANCE. IT IS AGREED THAT THIS APPLICATION, INCLUDING ANY MATERIAL SUBMITTED THEREWITH, SHALL BE THE BASIS OF THE INSURANCE AND SHALL BE, IN ALL STATES OTHER THAN NC AND UT, CONSIDERED PHYSICALLY ATTACHED TO AND PART OF THE POLICY, IF ISSUED. THE INSURER WILL HAVE RELIED UPON THIS APPLICATION, INCLUDING ANY MATERIAL SUBMITTED THEREWITH, IN ISSUING THE POLICY.
THE UNDERSIGNED AUTHORIZED REPRESENTATIVE OF THE APPLICANT ACKNOWLEDGES THAT ITS BROKER/PRODUCER IS NOT APPOINTED BY THE INSURER AND IS ACTING AS APPLICANT’S REPRESENTATIVE, AUTHORIZED TO PRESENT THIS APPLICATION ON ITS BEHALF TO THE INSURER. IN THIS CAPACITY THE BROKER/PRODUCER HAS NO UNDERWRITING OR BINDING AUTHORITY WITH THE INSURER AND CANNOT BIND COVERAGE OR MODIFY THIS APPLICATION OR ANY INSURANCE POLICY. ANY BINDER OR POLICY MODIFICATION WILL BE VALID ONLY IF ISSUED BY THE INSURER. APPLICANT FURTHER ACKNOWLEDGES THAT ANY FEES THAT IT PAYS TO THE BROKER/PRODUCER FOR THIS SERVICE IS AGREED TO IN WRITING BETWEEN APPLICANT AND THE BROKER/PRODUCER.
Notice to Arkansas, Minnesota, New Mexico and Ohio Applicants: Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false, fraudulent or deceptive statement is, or may be found to be, guilty of insurance fraud, which is a crime, and may be subject to civil fines and criminal penalties.
Notice to Colorado Applicants: It is unlawful to knowingly provide false, incomplete or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policy holder or claimant for the purpose of defrauding or attempting to defraud the policy holder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory agencies.
Notice to District of Columbia Applicants: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant.
Notice to Florida Applicants: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
Notice to Kentucky Applicants: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.
Notice to Louisiana and Rhode Island Applicants: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
Notice to Maine, Tennessee, Virginia and Washington Applicants: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.
Notice to Alabama and Maryland Applicants: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
Notice to New Jersey Applicants: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.
Notice to Oklahoma Applicants: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.
Notice to Oregon and Texas Applicants: Any person who makes an intentional misstatement that is material to the risk may be found guilty of insurance fraud by a court of law.
Notice to Pennsylvania Applicants: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.
Notice to Puerto Rico Applicants: Any person who knowingly and with the intention of defrauding presents false information in an insurance application, or presents, helps, or causes the presentation of a fraudulent claim for the payment of a loss or any other benefit, or presents more than one claim for the same damage or loss, shall incur a felony and, upon conviction, shall be sanctioned for each violation with the penalty of a fine of not less than five thousand (5,000) dollars and not more than ten thousand (10,000) dollars, or a fixed term of imprisonment for three (3) years, or both penalties. Should aggravating circumstances are present, the penalty thus established may be increased to a maximum of five (5) years, if extenuating circumstances are present, it may be reduced to a minimum of two (2) years.
Notice to New York Applicants: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall also be subject to: a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.
Notice: THIS POLICY PROVIDES COVERAGE ON A CLAIMS MADE BASIS. EXCEPT AS OTHERWISE PROVIDED HEREIN, PORTIONS OF THIS POLICY APPLY ONLY TO CLAIMS FIRST MADE DURING THE POLICY PERIOD OR THE EXTENDED REPORTING PERIOD (IF APPLICABLE) PURSUANT TO THE TERMS OF THIS POLICY.
DAMAGES AND LOSSES, INCLUSIVE OF CLAIMS EXPENSES, ARE INCLUDED WITHIN THE LIMITS OF LIABILITY, REDUCE AND MAY EXHAUST THE AVAILABLE LIMITS OF LIABILITY, AND SHALL BE APPLIED AGAINST THE RETENTION AMOUNT. THE INSURER SHALL NOT BE LIABLE FOR CLAIMS EXPENSES OR FOR THE AMOUNT OF ANY JUDGMENT, SETTLEMENT OR LOSS AFTER EXHAUSTION OF THE LIMITS OF LIABILITY.
THE UNDERSIGNED AUTHORIZED REPRESENTATIVE OF THE APPLICANT DECLARES THAT TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AFTER REASONABLE INQUIRY, THE STATEMENTS SET FORTH IN THE ATTACHED APPLICATION FOR INSURANCE ARE TRUE AND COMPLETE AND MAY BE RELIED UPON BY THE INSURER. IF THE INFORMATION IN THE APPLICATION CHANGES PRIOR TO THE INCEPTION DATE OF THE POLICY, THE APPLICANT WILL NOTIFY THE INSURER OF SUCH CHANGES, AND THE INSURER MAY MODIFY OR WITHDRAW ANY OUTSTANDING QUOTATION. THE INSURER IS AUTHORIZED TO MAKE INQUIRY IN CONNECTION WITH THIS APPLICATION.
THE INFORMATION REQUESTED IN THIS APPLICATION IS FOR UNDERWRITING PURPOSES ONLY AND DOES NOT CONSTITUTE NOTICE TO THE INSURER UNDER ANY POLICY OF ANY ACTUAL OR POTENTIAL CLAIM OR LOSS.
THIS AGREEMENT MAY BE EXECUTED BY PROVIDING AN ELECTRONIC SIGNATURE UNDER THE TERMS OF THE ELECTRONIC SIGNATURES ACT, 15 U.S.C. SS 7001 ET. SEQ., AND MAY NOT BE DENIED LEGAL EFFECT SOLELY BECAUSE IT IS IN ELECTRONIC FORM OR PERMITS THE COMPLETION OF THE BUSINESS TRANSACTION REFERENCED HEREIN ELECTRONICALLY INSTEAD OF IN PERSON.
- I, , am an authorized representative of the applicant and in completing this application I have made reasonable inquiry of members of the applicant's management responsible for information security, technology, compliance and operations. I understand that checking this box and signing constitutes a legal signature confirming that I agree with the terms and conditions and to the best to my knowledge and belief the statements set forth in the above application for insurance are true and complete and may be relied upon by the insurer.
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107 Technology Parkway Suite #205 Peachtree Corners GA, 30092
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Basic Information

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Data

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Security Controls

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Additional Information

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Final Step

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Quote

Basic Information

Data

Security Controls

Additional Information

Applicant Representations and Fraud Warnings

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