Cyber Insurance Quote | Brady Insurance

Proposer Information

Name ^*

Address ^*

Eircode ^*

Phone ^*

Email ^*

Trading as / Business Name ^*

Business Description ^*

Years Trading ^*

Projected Annual Turnover ^*

Personal Identifiable Records

Estimated number of PII records retained on company databases or file systems ^*

PII (Personally Identifiable Information) is defined as a personally identifiable record of an individual

Type of Personal Records held ^*

Payment Card Data
Healthcare Data
Other

If Other, Give details of PII being held by your company

Number of Employees ^*

Network Information

Do you have a Business Continuity Plan in force ^*

Yes
No

Are all Portable & Mobile Devices Encrypted ^*

Yes
No

Are Firewalls and Automatic Antivirus Updates in Place across your Network ^*

Yes
No

Physical forms of PII Disposed / Recycled by Confidential and Secure Methods ^*

Yes
No

Is all Sensitive & Confidential Information Encrypted ^*

Yes
No

Privacy Policy on your Website ^*

Including statement informing user of the information you collect

Yes
No

Do you have Process of Legal Review for all Media and Advertising Materials ^*

Yes
No

Confirm Compliance with Relevant Regulatory and Industry framewor ^*

Including HIPAA, PCI, Data Security Standard, CAN-SPAM Act, TCPA or similar

Yes
No

Historical Information

During the last 3 years have you:

Become aware of any Circumstance that could give rise to a claim ^*

Yes
No

Been Subject to Disciplinary or Regulatory Action, or Investigation ^*

Yes
No

Sustained any Network Outage, Intrusion, Corruption or Loss of Data ^*

Yes
No

Received any Injunction, Lawsuit, Fine, Penalty or Sanction ^*

Yes
No

Received Notice of any Privacy Violation or of the Compromised PII ^*

Yes
No

If you answer Yes to any of the above, Explain

Insurance Details

Have you made any Claims in the past 5 years ^*

Yes
No

Currently Insured ^*

Yes
No

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Historical Information

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