Cowbell Cyber Prime 250
Cyber insurance 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
If no, please provide security contact's name, email address and phone number below:
Business Details
(Legal) Business Name
*
Business Phone Number
*
Please enter your main business phone number.
Format: (000) 000-0000.
Is this business a Subsidiary / Franchise
*
Yes
No
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
Help describe your business
*
Please provide business website address:
Please provide your EIN number below:
Security Information
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 encrypt sensitive information stored on the cloud?
*
Yes
No
N/A (No sensitive information is stored on the cloud)
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 (security patching)?
*
Weekly
Monthly
Quarterly
6 months
Never
How often does the organization perform backups of business-critical data?
*
Weekly
Monthly
Quarterly
6 months
Never
If your organization performs backups, please select all answers that apply to your backups
*
Encrypted
Tested
Online or designated cloud service
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
Are all internet-accessible systems (e.g. web, email servers) segmented from the organization's trusted network (e.g. within a demilitarized zone (DMZ) or at a third-party service provider)?
Yes
No
Do agreements with third-party service providers require levels of security commensurate with the organization's information security standard?
Yes
No
Has the organization tested a full failover of the most critical servers?
Yes
No
Is the organization's manufacturing system segregated/air-gapped from the IT network?
Yes
No
Not applicable- applicant does not have a manufacturing system
Cyber Crime
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?
Past Activities
Has the organization filed any claims due to a cyber event in the last five years?
*
Yes
No
Has the organization ever been a party to a civil or criminal action or administrative proceeding alleging violation of any federal, state, local or common law?
Yes
No
Is there currently any pending litigation, administrative proceeding or claim against the named applicant, organization and/or any of the prospective insureds?
Yes
No
During the last three years, has the organization suffered loss of business income as a result of unscheduled system downtime?
Yes
No
During the last three years, has the organization suffered a security breach requiring customer or third-party notification according to state or federal regulations?
Yes
No
If yes to any of the above, please provide description including date of incident, current status and total amount incurred.
Coverage details
What coverage aggregate limit are you interested in buying?
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
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.
Privacy
Terms
An external non-invasive scan is conducted at the time of applying which may result in additional underwriting questions that will need to be addressed prior to binding coverage. For questions about completing this application, please contact Nate Weisenburger at nweisenburger@ga-ins.com or 989-817-4271.
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