FIADA Cyber Application for Cowbell

Cyber Insurance Application
- Name
  
  First NameLast Name
- Current Email Address
  example@example.com
- Is this person willing to serve as Cowbell's designated Information Security Contact?
- Main business phone number
  Please enter a valid phone number.Format: (000) 000-0000.
- Legal Business Name
- What type of business do you operate?
- Describe your business by industry / type
- Website Address(es)
- Business Address
  Street Address
- Street Address Line 2
- City
  City
- State
  State
- Year Established
  Please enter year when your business started
- Zip Code
  Zip Code
- Projected Annual Revenue
  Please enter projected 12 month revenue for your business
- Number of Employees
  Please enter number of employees at your business
- Has your organization ever been a party to a civil or criminal action or administrative proceeding alleging violation of any federal, state, local or common law?
- Is there currently any pending litigation, administrative proceeding or claim against the named applicant, organization and/ or any of the prospective insured?
- During the last three (3) years, has Your organization suffered a security breach requiring customer or third-party notification according to state or federal regulations, cyber extortion or business interruption arising from a cyber event?
- NOTE THAT IF YOUR ORGANIZATION HAS HAD ANY CYBER RELATED CLAIMS OR INCIDENTS WITHIN THE PAST THREE (3) YEARS, PLEASE STOP HERE AND CONTACT MIKE KEESE FOR NEXT STEPS: mkeese@wsins.com
- Does Your organization encrypt all emails containing sensitive information (including, but not limited to, Personally Identifiable Information (PII), Personal Health Information (PHI), Payment Card Information (PCI)) sent to external parties?
- Does Your organization encrypt all sensitive information (including, but not limited to, PII, PHI, PCI) stored on computing and/or mobile devices (including, but not limited to, phones, tablets, laptops, wearable computers, flash drives)?
- Does Your organization have an individual officially designated for overseeing information security?
- Does your organization have sensitive information (e.g. PII, PHI, PCI) stored on the cloud (including, but not limited to, Carbonite, Google Drive, Dropbox)?
- Does Your organization provide mandatory information security training to all employees at least annually?
- If yes, are Your information security personnel provided with additional training to help them understand current security threats?
- Social Engineering Coverage: Does your organization prevent unauthorized employees from initiating wire transfers?
- Social Engineering Coverage: Does your organization authenticate funds transfer requests (e.g.by calling a customer to verify the request at a predetermined phone number)?
- Social Engineering Coverage: Does your organization verify vendor/supplier bank accounts before adding to your accounts payable systems?
- Policy Effective Date Requested
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Policy Limit Requested
- Privacy
- Terms
- Terms and Conditions
- Should be Empty:

Cyber Insurance Application