Cyber Insurance Review Request

Name*

First Last

Business Name*

Email*

Phone*

Website

Risk Questions

Company Industry

State Head Office is Located in?*

Estimated annual total of transactions and records?*

Estimated Turnover?*

Are you Domiciled in Australia?*

Yes
No

Are all mobile devices (such as laptops, tables, smartphones and memory sticks) password protected?*

Yes
No

Are you aware of any matter that is reasonably likely to give rise to any loss or claim under such insurance, or have you suffered any loss or any claim including but not limited to a regulatory, governmental or administrative action brought against you, or any investigation or information request concerning any handling of personally identifiable information?*

Yes
No

Are you compliant with the Payment Card Industry (PCI) Standards, or if not compliant, do you process, transmit or store LESS than 1,000,000 financial transactions or records containing an individual's personal information per year?*

Yes
No
Don't Know

Do you use operating systems with embedded firewalls and anti-virus protection software (such as Windows or MAC OS X), or run commercially licensed separate firewall or anti-virus protection software?*

Yes
No
Don't Know

Is more than 25% of your revenue derived from the USA or Canada?*

Yes
No
Don't Know

Where applicable, do you comply with The Privacy Act 1988 (Privacy Act)?*

Yes
No
Not Applicable

Has an independent party completed an audit of your system/data security?*

Yes
No
Don't Know

Do you have firewalls protecting your own and customer/client data?*

Yes
No
Don't Know

Are all mission/business critical systems and data information assets backed up and stored at another location?*

Yes
No
Don't Know

Do you protect all Personally Identifiable Information through Encryption?*

Yes
No
Don't Know

Do you have a data Protection/Privacy policy?*

Yes
No
Don't Know

Do you outsource the handling of any personally Indentifiable Information?*

Yes
No
Don't Know

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