Finance Broker Cyber Proposal Form

Name

First NameLast Name

Insured Name (Company Name):

ABN:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:

Email

example@example.com

Website:

Business Activities:

Other

Last Year Annual Revenue

Estimated Annual Revenue This Year?

Number of Employees per State

Rows	QLD	NSW	VIC	SA	WA	TAS	NT	ACT	O/S
No.

Is more than 25% of your revenue from the USA?

Do you have any Financial agreements or contractual associations to countries other than Australia or New Zealand?

Please select Limit of Liability required (maximum 3 options):

Funds Transfer Fraud (Combined Crime and Social Engineering Cover) automatic limit of $25,000. If you require a higher limit please indicate below:

Do you require extension of Cover for your Contracted Consultants / Credit Representatives?

DO ALL CONTRACTED CONSULTANT/S: Deploy an active business grade firewall at all external gateways of your network and an active business grade antivirus application across your entire network, including servers or endpoints?

DO ALL CONTRACTED CONSULTANT/S: Have (or your cloud service provider) backup your data to an isolated environment at least every 7days and test it at least every 365 days?

DO ALL CONTRACTED CONSULTANT/S: Secure all remote access to your network with a minimum of multifactor authentication?

DO ALL CONTRACTED CONSULTANT/S: Install critical patches within 30 days of release?

Do you have a written services / consultation / Contractor agreement in place with each and every Contracted Consultant / Credit Representative?

Do ALL the Contacted Consultants access your network using two Factor Authentication with no Remote desktop protocols open?

I / We Understand that if the insurer agrees to extend cover to include Contracted Consultant/s, any listed Contracted Consultant noted on the policy would only be provided cover in relation to an insurable cyber event from them accessing the insured entities network.

CYBER UNDERWRITING QUESTIONS

1. Do you deploy an active business grade firewall at all external gateways of your network and an active business grade antivirus application across your entire network, including servers or endpoints?

2. Do you (or your cloud service provider) backup your data to an isolated environment at least every 7 days and test it as least every 365 days?

3. Do you secure all remote access to your network with a minimum of multifactor authentication?

4. Do you install critical patches within 30 days of release?

5. Have you suffered any loss or has any claim been made against you or are you aware of any matter that is reasonably likely to give rise to any loss or claim in the last 36 months where you would seek an indemnity from our cyber insurance policy?

6. Would you like a KYND Cyber Risk Report? (KYND Report is a Cyber Risk Vulnerability Report, designed to help better understand your cyber vulnerabilities and potential exposures. KYND is a non-invasively scans for publicly visible software and services that are owned by an organisation, visible on the internet, identifying threats and providing some recommended actions for your further consideration.)

FUNDS TRANSFER FRAUD (Combined Crime and Social Engineering Cover)

6. Do you have a written procedure whereby, all new (including changes to existing) payment details or contact details are confirmed by an alternative method to the original method used, before any payment is made?

7. Do you maintain procedures, at least annually, for the provision of written training materials to all employees relating to the dangers of social engineering fraud, phising and cyber fraud?

Disclaimer: D. R. Loades Enterprises Pty Ltd is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Ltd, AFSL 240549. Corporate Authorised Representative No. 321052

Phone: 1300 769 163 Email: fbpi@iaa.net.au Website: www.insuranceadviser.net/drloades

Name:

Date:

Signature