Cyber Insurance Quote

General Information

Company Name:*

Contact Name:*

Contact Email:*

Contact Phone Number:*

Address:*

City:*

State:*

ZIP Code:*

Number of Employees:**

Number of Locations:**

Website:*

Revenue (most recent annual**)

**Estimated: Check the box below if you believe the figures provided are within 20 percent of actual.

To the best of my knowledge the figures provided are within 20 percent of actual.

Known Company Details

Please answer the following to the best of your knowledge.

The company identified in Section 2, does not maintain directly or indirectly, more than 2 million records.
Note: records can be defined as:
a. Government identification numbers (e.g. social security or driver’s license numbers)
b. Credit card numbers, debit card numbers or other financial account numbers
c. Health care or medical records
d. Confidential corporate information of others (e.g. information under NDA, M&A information)
e. Other private, confidential or sensitive information not identified in a.–d.

The company identified in Section 2, has not had any claim for which coverage may apply under this proposed coverage in the last five years.

The company identified in Section 2, does not operate any of the following:
Financial institutions, retail, health care, health exchanges, adult, gambling/casinos, collection agents, credit bureaus, credit card processing, payment processing, mobile payment provider, online brokers/dealers, data brokers, data aggregators (sole purpose), information exchanges, online gaming, search engines, social networking sites (as operations), utility(ies), college/university(ies), technology providers (i.e. software companies, IT security companies, cloud providers)

Coverage Requested
Core Coverage Limit Retention Currently in force? Maximum limits with this application
Breach Liability
Privacy liability YesNo $5,000,000
Website media liability YesNo $5,000,000**
Regulatory YesNo $250,000
Payment card industry (PCI) YesNo $250,000
Breach Rectification
Data breach team YesNo $5,000,000
Business interruption 48 hours YesNo $5,000,000
Digital asset loss YesNo $5,000,000
Digital Crime
Cyber extortion YesNo $5,000,000
Electronic transfer of funds YesNo $100,000**
Deceptive transfer YesNo $100,000**
Telephone toll fraud YesNo $100,000**

**Select industry classes may require additional underwriting regardless of limit.

Additional Comments

Coverage provided by Schinnerer