Cyber Insurance Quote Request

Insured Name *

Address of Head Office *

City *

State *

Postcode *

Contact Person *

Email *

Phone *

Business Occupation / Industry *

Revenue - Last 12 Months *

Are you Domiciled in Australia *

Yes
No

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

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

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

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

Do you outsource any part of your network, including storage? *

Yes
No

To Whom? *

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

Yes
No

Do you wish to have cover for Social Engineering, Phishing & Cyber Fraud? *

Yes
No

Are all requests to alter supplier and customer details including bank account details, independently verified with a known contact for authenticity? If No, this cover is unavaliable. *

Yes
No

Do you ensure that at least two members of staff authorise any transfer of funds, signing of cheques (above $2,000) and the issuance of instructions for the disbursement of assets, funds or investments? If the answer is No, this cover is unavaliable. *

Yes
No