Discovery Form - FifthWall Solutions

1

Calendar Meeting Override

Wilson Henry (no link)

Travis Kroger

Oscar Ramirez (no link)

Type option 4

2

Does your business have a cyber insurance policy?* This field is required.

Yes

No

I don't know

3

Please attach your full policy here.* This field is required.The policy document should be approximately 30-60 pages. FifthWall will review your policy and make sure you have sufficient coverage for your business.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

4

Business Entity Name* This field is required.

5

Primary Business Entity Website Domain* This field is required.

6

Business Contact Name* This field is required.

First Name

Last Name

7

Business Contact Email Address* This field is required.Please use the email address linked to your organization.

example@example.com

8

What's your estimated gross annual revenue over the next 12 months?* This field is required.Why we ask for revenue: The two largest factors for carriers to rate a quote for a client is based on (a) revenue and (b) industry.

9

Number of Employees* This field is required.

10

Do you have a formal wire transfer fraud/policy/process, with executive sponsorship, to require additional confirmation/security for all payments over $25K?* This field is required.In other words, "Are you making sure your business always has at least two people to approve wire transfers over $25K?"

Yes

No

11

Do you enforce procedures to remove content (including third-party content) that may infringe or violate any intellectual property or privacy right?* This field is required.

Yes

No

12

How many PII records do you collect, process, store, transmit, or have access to?Only answer if you collect, process, store, transmit, or have access to any Personally Identifiable Information (PII) other than your employees information. It is rare for a company to to carry zero PII records.

Less than 100,000

100,000 - 250,000

250,001 - 500,000

500,001 - 1,000,000

More than 1,000,000

13

Who sent you this form? * This field is required.This would typically be a third-party IT professional or managed service provider.

First Name

Last Name

14

What's their email address?* This field is required.This would typically be a third-party IT professional or managed service provider.

Email Address

15

One more thing: Once you hit "Submit", we'll reach out with a scheduling link for you and your security advisor to meet with one of our cyber insurance specialists.

In 30 minutes or less, we'll:
(a) Review an assessment of your risk profile
(b) Look at starting a submission for competitive quotes
(c) Ensure you find the right coverage at the right price

16

Let us know when you can meet with your IT Contact and a FifthWall cyber expert, then select the green "Submit" bar below once scheduled.In 30 minutes or less, we'll (a) Review an assessment of your risk profile, (b) Look at starting a submission for competitive quotes, and (c) Ensure you find the right coverage at the right price. After you select a time, we'll invite your IT contact as a guest.

17

Submission Checklist

LOTA

Discovery Form

18

Discovery Form

Y

N

19

Revenue

20

Hard Code IT Contact Info

Yes

21

Revenue - Prior Fiscal Year