Cyber Insurance

Thank you for considering our on-line cyber insurance service. Because Greater National Group is an insurance broker, not an insurance company, we will process your application with major insurance companies in order to find the right cyber insurance for you.

Please fill in the following form as fully as possible, then click 'submit' at the end of the form.
You can use the TAB key to move to the next field. We will respond with your terms as soon as we have researched the market for the right available deals that fit your requirements.

Policy Covers

1. Annual aggregate limit (please select from list):
2. Occupation:
3. Business description:
4. Estimated annual turnover:
5. Estimated annual total of transactions and records:
6a. Do you comply with your relevant PCI DSS obligations?
6b. Where applicable, do you comply with The Privacy Act 1988 (Privacy Act)
6c. Has an independent party completed an audit of your system/data security?
6d. Do you have firewalls protecting your own and customer/client data?
6e. Are all mission/business critical systems and data information assets backed up and stored at another location?
6f. Do you use antivirus, spyware and malware detection software?
6g. Do you protect all Personally Identifiable Information through Encryption?
6h. Do you have a data protection/Privacy policy?
6i. Do you outsource the handling of any Personally Identifiable Information?

Duty of Disclosure:
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?
Yes No
If so, please provide details:
I/We hereby declare that:
My/Our attention has been drawn to the Important Notices accompanying this form and further I/we have read these notices carefully and acknowledge my/our understanding of their content. The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter between the date of this form and the inception date of the insurance to which this relates I/we shall give immediate notice thereof. I/We authorise GNG and the Insurer to collect or disclose any personal information about another individual (for example, an employee, or client), I/we declare that the individual has been or will be made aware of that fact and the Privacy Policy. I/We also confirm that I/we am/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this form and I/we complete this form on their behalf.
Any other comments, requests or relevant information you need to add:
Contacting you about your quote:
In order to select the most appropriate cover for you, it may be important to discuss quote details in person. Please leave a contact phone number and best time to call to facilitate this.
Your full name:
Company/Business/Name of Applicant to be Insured:
Your phone number (please include area code):
Your mobile phone number:
Best time(s) to call:
Please send my quote by (select at least one):
email phone fax mail
Your email address:
Your website address:
Your fax number:
Your postal address: