CyberSecurity Insurance

Complete the online application form below to receive your quote. For any questions, please reach out to Laurie Silvey at Laurie Silvey Business Name Website Address Email Domains Primary Contact Position/Title Phone Number Email Address Company Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Physical Address (If Different) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Industry Sector Number of Employees Annual Company Revenue Business Activities: Does your company engage in any of the following activities? Check all that apply Adult Content Cryptocurrency or Blockchain Services Gambling Credit Card Processing Managed Service Provider (MSP) Managed Security Service Provider (MSSP) Remote Network Administration Services Select All

Cybersecurity Risk History

1. Have there been any cybersecurity-related claims or potential claims within the past three years (whether insured or not?) Yes No

If yes:

Number of Claims Total Amount Paid (If any) Brief description of each incident 2. Are you aware of any circumstances that may lead to a future claim? Yes No If yes, provide a brief explanation

Data & Security Practices

Do you encrypt all laptops, computers, and other company devices? Yes No Approximate number of annual credit card transactions Number of PII (Personally Identifiable Information and/or PHI (Protected Health Information) records stored by the company How often are your networks and files backed up to an offline or separate environment? Daily Weekly Monthly Other(specify) Other (Specify) How often is your backup restoration process tested? Quarterly Semi-annually Annually Other (Specify below) Other (specify)

Authentication & Access Controls

Email Accounts Yes No Virtual Private Networks (VPN) Yes No Remote Desktop Protocols (RDP) Yes No Network/Cloud Administration Accounts Yes No

Financial Controls

Do you verify payroll, ACH, and wire transfer requests through a secondary verification method (separate from the original request?) Yes No

Content & Website Management

In the past three years, have there been any complaints regarding your social media, website, or published content? Yes No Do you have a process for removing website content that may violate intellectual property or privacy rights? Yes No

System Maintenance & Threat Protection

Do you maintain a process for implementing critical system updates/patches? Yes No If yes, how quickly are updates typically applied? Within 24 hours Within 72 hours Within one week Other (specify below) Other (specify) Do you scan incoming emails for malicious attachments and links? Yes No Do you use endpoint protection (e.g., antivirus, anti-malware)? Yes No Do you use a third-party IT service provider? Yes No If yes, provide the name of the provider CAPTCHA Save & Continue