Main Contact – Name(s)

Email

Phone Number

Postal Address

Entity Name

Insured Entity Type
Sole TraderPartnershipPublic Listed CompanyNot For ProfitPrivate Company (Pty Ltd)

ABN

Is the Policyholder a subsidiary, franchisee or smaller company of a larger group?
YesNo

Insureds Website Address

Are you domiciled in Australia with no subsidiaries outside Australia or New Zealand
YesNo
If No please advise where else you operate

Occupation

Do you perform work for the Defence industry or Federal Government or are you a member of the Defence Industry Security Program (DISP)?
YesNo

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

Do you enforce a restricted access management policy for administrator rights and critical resources?
YesNo

Are staff trained on cyber security?
YesNo

How frequently does the Policyholder provide security awareness training to their employees?
NeverAnnuallyQuarterlyMonthlyOther

How often do you back up sensitive, confidential, critical or valuable data?

Have you implemented a critical security patch management process for your IT systems
YesNo

Is Multi-Factor Authentication (MFA*) required to access the following systems/platforms/services?
YesNo

Is Multi-Factor Authentication (MFA*) required to access the following systems/platforms/services?
YesNo

All remote access to the network?
YesNo

Web-based email
YesNo

Admin / Privileged Service Accounts
YesNo

Cloud resources, including backups?
YesNo

How frequently do you take regular backups of critical data and systems?
DailyWeeklyMonthlyGreater than monthly

Do you keep a copy of critical backups offline, segregated from and inaccessible to your network?
YesNo

How do you back up your data?

In the cloud
YesNo

On Premises
YesNo

At a Secondary, Offsite Data Centre
YesNo

Encrypted
YesNo

MFA Protected
YesNo

Uses Immutable Technology
"Uses Immutable Technology" typically refers to systems or solutions that rely on immutability—the principle that once something is created, it cannot be altered or deleted. This concept is widely used in tech to enhance security, reliability, and data integrity.

YesNo

Do you have any of the following in place?
A data breach response planA business continuity plan / disaster recovery plan which takes cyber perils into considerationAn IT security policy / framework

Is the Disaster Recovery Plan or Business Continuity Plan tested annually?
Not ApplicableYesNo

After how long will your business be impacted by a loss to your site/systems?
0-6 hours6-12 hours12-24 hoursAbove 24 hours

After enquiry, within the past 5 years, is the Policyholder aware of any losses, claims, circumstances, cyber events, privacy breaches, regulatory investigations, crime or social engineering incidents which have impacted, or could adversely impact your business or give rise to a claim under a cyber policy?
YesNo

Have you had any unforeseen down time to your website or IT network of more than 8 hours?
YesNo

Criminal Financial Loss

Do You Want Optional Cover For Criminal Financial Loss (Incl. Cyber Theft, Telephone Phreaking & Cryptojacking)?
YesNo

Directors and Officers Liability

Do you want Optional Cover for Directors and Officers Liability?
YesNo

Non-IT Contingent Business Interruption and System Failure

Do You Want Optional Cover For Non-IT Contingent Business Interruption And System Failure?
Non-IT Contingent Business Interruption and System Failure refers to insurance coverage that protects a business when its operations are disrupted due to a cyber event or system failure at a third-party supplier

YesNo

Tangible Property

Do You Want Optional Cover For Tangible Property?
Tangible property under a cyber insurance policy typically refers to physical assets
YesNo

Excess
$2,500$5,000$7,500$10,000

Business Interruption Indemnity Period
30 Days60 Days90 Days180 Days365 Days

Aggregate Limit
$250,000$500,000$750,000$1,000,000More

Previous Claims Declined?
Please SelectYesNoLet's Discuss

Ever been liable for any civil offence or pecuniary penalty?
Please SelectYesNoLet's Discuss

Ever been charged or convicted of a criminal offence?
Please SelectYesNoLet's Discuss

Ever had an insurance policy cancelled, declined or terms imposed?
Please SelectYesNoLet's Discuss

Aware of circumstances which could give rise to a claim?
Please SelectYesNoLet's Discuss

Anything to Declare under Duty of Disclosure?
Please SelectYesNoLet's Discuss

let's SIMPLIFY MY INSURANCE