Client Quote Submittal - Beltex Production

  • Are you an Managed Services or Technology Service Provider (MSP/TSP)? Do not fill this application for insurance out, but rather click here for more information on how Beltex can help insure you and your customers.

  • Your technology partner has passed your information along to us because you had expressed interest in a Commercial Cyber Insurance Policy. If you aren't quite sure why you have gotten this, please reach out to them at {mspemail}.

    For your convenience, they have pre-filled a number of fields for you, but please ensure their accuracy before submitting this form to get an insurance quote.

    Thank you!

    Beltex Insurance

    • Your Basic Business Information 
    • Format: (000) 000-0000.
    • Date established*
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    • Any cyber liability claims in the last 3 years?*
    • 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?*
    • Has your organization ever been a party to any of the following: a. Civil or criminal action or administrative proceeding alleging violation of any federal, state, local or common law?*
    • Has your organization ever been a party to any of the following: b. Is there currently any pending litigation, administrative proceeding or claim against the named applicant, organization and/or any of the prospective insured?*
    • Is your billing address the same as your physical address?
    • Is your mailing address the same as your physical address?
    • Underwriting Questions 
    • Do you or your employees verify vendor/supplier bank accounts before adding to your accounts payable systems?*
    • Do You have an established and documented verification procedure requiring that You or Your employees authenticate all funds transfer requests, whether made to a third-party or otherwise by way of a secondary method of communication from the initial request for funds transfer (as one example, by calling the intended recipient to verify the request at a predetermined phone number if the funds transfer request was made by email)?*
    • Do you or your employees prevent unauthorized employees from initiating wire transfers?*
    • Does your organization leverage 24x7 managed EDR on all endpoints? A "Yes" is required to qualify for coverage ("Yes" is required to qualify for coverage.)*
    • Do you prevent the external exposure of Remote Desktop Protocol (RDP) from being open to the internet, either on the default port of 3389 or any others? ("Yes" is required to qualify for coverage.)*
    • Does the applicant utilize a Security Information and Event Management system (SIEM) that includes 1 year of retention of all logs sent to the system (ex: endpoints, authentication, system, audit logs, etc.), detections that are written by security specialists and delivered in near real-time, and includes log-level visibility that is readily available for search/export?*
    • 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? ("Yes" is required to qualify for coverage.)*
    • Does Your organization have sensitive information (e.g., PII, PHI, PCI) stored on the cloud (including, but not limited to, Carbonite, Google Drive, Dropbox, Office 365)?*
    • Does your organization provide mandatory information security training to all employees at least annually? ("Yes" is required to qualify for coverage.)*
    • If yes, are your information security personnel provided with additional training to help them understand current security threats? ("Yes" is required to qualify for coverage.)*
    • Please identify which of the following Event Response measures your organization has in place*
    • Desired Effective Date of Policy (must be within 60 days)*
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    • As part of this proposal for a cyber policy, coverage is automatically included for losses resulting from certified acts of terrorism, as defined in Section 102(1) of the Terrorism Risk Insurance Act for a premium charge of no more than $2. If you choose to reject this coverage, your policy will be modified to exclude all certified acts of terrorism.

    • Do you wish to reject the inclusion of Terrorism Insurance Coverage? By selecting yes, you affirm that you choose to decline to purchase coverage for certified acts of terrorism, as defined in Section 102(1) of the Act.  You affirm that you understand that you will not have coverage for any losses resulting from any certified acts of terrorism and that an exclusion of certain terrorism losses will be made part of this policy.*

    • BELTEX INSURANCE AGENCY, LLC is a licensed insurance agency, not an insurer. Cyber Insurance is underwritten by Spinnaker Insurance Company and produced by BELTEX INSURANCE AGENCY, LLC. BELTEX INSURANCE AGENCY, LLC receives compensation based on the premiums for the insurance policies it sells.

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