Brown & Brown - MWFPA Cyber Program
Application
Please provide us with your contact information
Name
*
First Name
Last Name
Current Email Address
*
example@example.com
Is this person willing to serve as Cowbell’s designated security contact?
*
Yes
No
Business Details
(Legal) Business Name
*
Business Phone Number
*
Please enter your main business phone number.
Format: (000) 000-0000.
Business Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Projected 12 Month Revenue
*
Please enter projected revenue for the business
What type of business do you operate?
*
Please Select
Government entity
Private entity
Publicly traded entity
Non-profit
Investment fund
Number of Employees
*
Please enter number of employees for the business
Year Established
*
Please enter year the business was established
Business website
Please enter a business website if one exists
Help describe your business
*
Security Information
Have you had any past cyber insurance claim(s)?
*
Yes
No
Does your organization provide information security training to all employees at least annually? If not, are you willing to implement it during the policy period?
*
Yes
No
Does your organization encrypt all emails, mobile and computing devices containing sensitive information sent to external parties?
*
Yes
No
Does your organization have sensitive information stored on the cloud?
*
Yes
No
Social engineering is coverage for a loss when the policy holder is intentionally misled to transfer money to a person, place or account from good faith reliance upon an instruction transmitted via email by an imposter. This is often referred to as 'phishing'. Do you want to answer a few more questions to request this coverage?
*
Yes
No
If yes, select all that apply to your organization:
You authenticate funds transfer requests (e.g.by calling a customer to verify the request at a predetermined phone number)?
You verify vendor/supplier bank accounts before adding to their accounts payable systems?
You prevent unauthorized employees from initiating wire transfers?
Does your organization enforce Multi-Factor Authentication (MFA) for all employees, contractors, and partners? Select all that apply
*
No
Yes - email
Yes - cloud deployment
Yes - mission critical systems
Yes - remote access
How often does your organization apply updates to critical IT systems and applications?
*
Weekly
Monthly
Quarterly
6 months
Never
How often does the organization perform backups of business-critical data?
*
Weekly
Monthly
Quarterly
6 months
Never
Are your back-ups
*
Encrypted
Tested
Online or designated cloud service
Other
Does the organization have an incident response plan - tested and in-effect - setting forth specific action items and responsibilities for relevant parties in the event of cyber incident or data breach matter?*
*
Yes
No
Coverage details
What coverage aggregate limit are you interested in buying?
*
$1,000,000
$2,000,000
$3,000,000
Terms and Conditions
*
I attest that the information presented is a complete, true and accurate representation on this business and understand that any fraudulent intent is subject to criminal and civil penalties.
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Terms
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