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Cyber Insurance Quote Form
Contact Details
Risk Details
Full business name of applicant
ABN
Head office address
Date established
Website address
Business description/industry
Revenue for the past 12 months
$
Gross Revenue from on-line sales or service
$
Number of Employees
Please state the approximate number of debit/credit card transactions processed in the last 12 months
How many servers does the Applicant either own or otherwise have dedicated to their use?
What is the Applicant’s total number of IP addresses?
Does the Applicant collect, store or process personally identifiable or other confidential information?
Yes
No
If yes, how many records are held, including the Applicant’s prospective, current and former customers and employees?
Combined number of clients/customer records and total number of credit card transactions
0 – 10,000
10,001 – 25,000
25,001 – 50,000
50,001 – 75,000
75,001 – 100,000
100,001 – 200,000
200,001 – 300,000
300,001 – 400,000
400,001 – 500,000
500,001-750,000
750,001 – 1,000,000
1,000,001 – 1,500,000
1,500,001 – 2,000,000
2,000,001 – 2,500,000
2,500,001 – 5,000,000
>5,000 000
If greater than 5,000,000 please provide a total number
We confirm that the Applicant and all subsidiaries:
Have up to date anti-virus and fire wall protection installed and operating on all computers systems.
Yes
No
Have a security policy that identifies and stipulates the types and levels of protection for all of the Applicant’s information assets, whether electronic or otherwise and whether held by the Applicant or by a person or organisation providing services to the Applicant.
Yes
No
Conducts penetration testing of the systems and actively monitor network traffic to regularly identify and assess new threats and adjust the security policy (and protection procedures) to address the new threats.
Yes
No
Conduct back-up and recovery procedures on all sensitive and financial data on at least a weekly basis.
Yes
No
Have written agreements in place between the Applicant and any third-party IT service provider and that such agreements confirm a level of security consummate or better to the Applicants own security.
Yes
No
Email address
