Cyber Liability Quote Request

Cyber cover pays the costs that follow a breach or ransomware attack — notifying affected customers, restoring systems, legal defence, and the income you lose while you are down. Most business policies exclude all of it.

Fill in what you know and leave the rest blank — only your name, email and phone are required. We will come back to you for anything missing. Nothing here is an application and nothing is binding.

Your business Business Name

DBA / Trading AsOnly if different from the name above.Business Structure

Business Address

CityZIP Code

Mailing AddressOnly if your mail goes somewhere else.

Your First NameYour Last Name

Email AddressPhone Number

Years in BusinessApproximate Annual RevenueA rough figure is fine.

WebsiteIf you have one.

Your data and systems What Kind of Information Do You Hold?

Roughly How Many People's Records Do You Hold?Where Is It Stored?

Any Outside Companies With Access to Your Systems or Data?

Do You Take Card Payments?

Your security

Do You Use Two-Step Login?A code or app prompt on top of a password. Also called multi-factor authentication.If Yes, Where?For example email, remote access, banking.

Is Your Data Encrypted?Do You Back Up Your Data Regularly?

If Yes, How Often and Where?Do You Train Staff on Phishing and Security?

Do You Have a Written Plan for Handling a Breach?

The cover you want

Cover Limit You WantLeave blank and we will recommend.Do You Want Cover for Income Lost While Systems Are Down?

Your current cover and timing Any breach, ransomware or cyber incident in the past 5 years?

Current or Previous InsurerIf you are switching or renewing.What You Pay NowIf you know it.

When Do You Need Cover to Start?

Anything Else We Should Know

This is a solicitation for insurance. Completing this form does not apply for or bind cover. Coverage cannot be bound or changed via this form, e-mail, voicemail, text, or facsimile — only by written confirmation from our office.

Would you rather fill it in on paper?

Download the same questions as a printable form, or as a Word file you can type into, and bring it in or send it back to us.

PDF version · Word version · All quote request forms

Would you rather fill it in on paper?

Rather just talk it through?