Cyber Liability Application


3. Do you have a firewall?

4. Do you have a virus protection program in place?

5. Do you outsource a critical part of your internal network/computer system of internet access/presence to others? If yes, please explain

6. Do you have a written privacy or security policy?

7. Do you control access to your computer systems?

8. Does your hiring process include criminal background checks?

9. Have you ever experienced a privacy or security breach? If yes, please explain

10. Do you have a program in place to test your security/privacy controls? Including the services of your venders?

11a. Do you allow employees to download Personally Identifiable information of customers or confidential information in your care belonging to third parties onto laptops or other storage media?

11b. If yes, is the information encrypted?

12. Types of Personally Identifiable Information held (check all that apply)

This non-binding premium indication form is for a “non-binding premium estimate” for the prospective insured. A contract of insurance cannot be confirmed and the resulting indication is subject to change.

For more information or to receive a quote, please contact us at (888) 363-4747 or via email at



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