Business Entity Name:
ABN:
Occupation/Business Description:
Business Address:
Annual Turnover:
Turnover Split by State/Territory:
Business Website Domain:
Email Address:
Contact Number
Number of Employees:
Do you implement encryption on laptop computers, desktop computers, and other portable media devices?
YesNo
Do you collect, process, store, transmit, or have access to any Payment Card Information (PCI) or Personally Identifiable Information (PII) other than your employees?
If Yes, how many PII records does your business collect, process, store, transmit, or have access to?
What is the estimated annual volume of payment card transactions?
Within the last 3 years, have you been subject to any complaints concerning the content of your website, advertising materials, social media, or other publications?
YesNo
Do you enforce procedures to remove content (including third-party content) that may infringe or violate any intellectual property or privacy right?
YesNo
For which of the following services do you enforce Multi-Factor Authentication (MFA)?
EmailVirtual Private Network (VPN), Remote Desktop Protocol (RDP), RDWeb, RD Gateway, or other remote accessNetwork/cloud administration or privileged user accounts
Does your business require a secondary means of communication to validate the authenticity of:
a) Funds transfer requests (ACH, wire, etc.) before processing a request in excess of $2,000
YesNo
b) Any request to change banking details (ACH, wire, payroll distribution, etc.)?
YesNo
During the past three years, did your business experience a cyber incident, claim or loss, whether insured or not, which could have been covered under a policy similar to the proposed insurance, this includes but is not limited to any
Actual or reasonably suspected data breach or security failure, including notifying consumers or third parties of a data breach or security failure
YesNo
Claims or complaints with respect to privacy injury, breach of information or network security, unauthorised disclosure of information, defamation, or content infringement
YesNo
Government action, investigation, or subpoena regarding any alleged violation of a privacy law or regulation
YesNo
Actual or attempted extortion demand with respect to its data or computer systems
YesNo
Are you aware of any circumstance that could give rise to a claim under this insurance policy?
YesNo
Do you have knowledge or information regarding any fact, circumstance, situation, or event that could reasonably give rise to a claim or loss under the proposed insurance?
YesNo
What date would you like the policy to start from?
100% Australian Owned 
1300 467 872
We are 100% Australian owned