CGIB Cyber Insurance Online Quote Form

CGIB Cyber Insurance Online Quote Form
Please complete the following information and submit this form to obtain a Cyber insurance quotation for your business.

Click on the following link to learn more regarding Cyber Insurance.

Cyber Insurance

All information you provide must be correct, true, and accurate as incorrect or misleading information may alter our quote and jeopardise cover if you proceed with a policy.

Please ensure you read the CGIB Customer Information Page before filling out this form. This includes essential documents such as our Financial Services Guide, General Advice Warning, Privacy Statement, and Duty of Disclosure.
Policy & Business Details
Named Insured*
Insured ABN*
Website*
Occupation *
Annual Revenue*
USA Revenue % *
Year Established*
Number of Employees *
Client Security Officer Details
Client Security Officer Details - Please provide contact details for the client's Chief Information Security Officer or other staff member who is responsible for data and network security and/or responsible for the contract with a managed 3rd party vendor*
Underwriting Questions
Does the client currently or will the client potentially operate in any of the following?*

None of theseAccreditation ServicesAdult ContentCredit BureauCryptocurrency / Distributed Ledger TechnologyCybersecurity Product or ServicesData Aggregator / Data Brokerage / Data WarehousingGambling IndustryIT Managed ServicesLocal or Regional AuthorityManufacturer of Life Safety Products or ServicesPayment Processing or Trading ExchangesPeer to Peer File SharingSocial Media Platform Provider (excludes Named Insured own use of Social Media Platforms)Digital SurveillanceThird Party Claims Administration
Does any part of your network (including email) maintain remote access capability?*

YesNo
Please confirm if your backups for mission critical systems are protected by the following:*

None of theseImmutable or write-once read-many protectionsAccess to backups is restricted via multi-factor authenticationCompletely offline or air-gapped (tape or non-mounted disk) that is disconnected from the rest of your networkAccess to backups is restricted via separate privileged accounts that are not connected to active directory or other domains
Please confirm which of the following endpoint protection technologies are in place on all laptops, desktops, and servers:*

None of theseURL or web filteringApplication isolation and containmentCentralised Endpoint Protection PlatformAdvanced antimalware and antivirus with heuristic capabilitiesEDR (endpoint detection and response), XDR (extended detection and response), or MDR (managed detection and response)
Please confirm which of the following email security measures are in place:*

None of theseQuarantine service for suspicious emailsAbility to detonate attachments and links in a sandboxSender Policy Framework (SPF) is enforcedPhishing simulations or training for employeesMicrosoft Office macros are disabled on documents by default
Does the possible maximum number of people you would be required to notify in case of a breach of Personally Identifiable Information (PII) exceed 500,000? *

YesNo
Do you, or your outsourced service provider, accept payment card transactions?*

YesNo
Are you compliant to the level of PCI DSS that applies to your company?*

YesNo
To the best of your knowledge, do you comply with all relevant privacy laws and regulations in the jurisdictions in which you operate?*

YesNo
Is the client a subsidiary, franchisee, or smaller entity of a larger organisation?*

YesNo
Please provide additional details*
Does the Applicant 1. Derive any revenue from Russia, Belarus, or Ukraine (including Crimea and the Luhansk and Donetsk regions)? 2. have any operations, products, subsidiaries, employees, property or facilities in Russia, Belarus, or Ukraine (including Crimea and the Luhansk and Donetsk regions)? 3. or have any supply chain reliance on companies or resources located in Russia, Belarus, or Ukraine (including Crimea and the Luhansk and Donetsk regions)?*

YesNo
Within the last 3 years, have you had any Cyber Incidents, known cyber events or become aware of any matter that could lead to a claim under a cyber insurance policy?*

YesNo
Please provide additional details *
Has the Applicant's Cyber or Technology insurance submission previously been declined by Chubb, or is Chubb currently the insurer for either policy?*

YesNo
Please provide additional details *
I confirm that the information declared herein is a true and correct declaration of my client / the policyholder's completed proposal form and that I have obtained a declaration to that effect from my client, which I am able to produce if requested to do so*

YesNo
Limits and Coverage
Policy Aggregate *
Retroactive Coverage *
Please provide a date*

DayMonthYear
Date
Please provide a breakdown of each state.

Please provide a breakdown of each state you work in. Total must equal 100% - Please ensure all boxes are filled; for those you don't need coverage for, just use "0".
NSW*
Total must equal 100%*
ACT*
VIC*
QLD*
SA*
WA*
TAS*
NT*
Overseas *
Coverage Required
All coverage options are pre-selected as we strongly recommend comprehensive protection. However, if you wish to exclude any coverage, you may do so by unticking the respective option. Please note that removing coverage may leave you uninsured and exposed to financial loss.
Incident Response Expenses - Incident Response Expenses by reason of a Cyber Incident or a Business Interruption Incident discovered by any Control Group member during the Policy Period and reported to the insurer. Subject to the insurers policy wording.Business Interruption - Loss of net profits and continuing operating expenses from interruptions of insured's systems; and with contingent business interruption, adds losses due to interruption of outsourced technology provider's systems. Subject to the insurers policy wording.Data and System Recovery - Data and System Recovery Costs during the Period of Indemnity, arising from a Business Interruption Incident discovered by any Control Group member during the Policy Period. Subject to the insurers policy wording.Cyber Extortion - Cyber Extortion Damages and Cyber Extortion Expenses by reason of a Cyber Extortion Event discovered by any Control Group member during the Policy Period. Subject to the insurers policy wording.Privacy and Network Liability -Damages and Privacy and Network Security Claims Expenses by reason of a Privacy and Network Security Claim first made during the Policy Period resulting from any Privacy and Network Security Wrongful Act taking place after the Retroactive Date and prior to the end of the Policy Period. Subject to the insurers policy wording.Emergency Incident Response -Emergency Incident Response Expenses incurred within the first 48 hours immediately following the discovery of a reasonably suspected or confirmed Cyber Incident or Business Interruption Incident by any Control Group member during the Policy Period and reported to Us pursuant to General Condition 5.10 Notification, which requires immediate attention in order to mitigate the damage from, effects of and costs related to such Cyber Incident or Business Interruption Incident. Subject to the insurers policy wording.Media - Liability following defamation or copyright and trademark infringement online costs. Subject to the insurers policy wording.Betterment costs - Betterment Costs arising from a Business Interruption Incident. Subject to the insurers policy wording.Cyber Crime - Direct Financial Loss solely as a result of Theft of Your Money or Securities due to Malicious Use or Access of a Covered Computer System by a Third Party and Discovered during the Policy Period. Subject to the insurers policy wording.Reward Expenses -Reward Expenses solely to the extent used in direct connection with a Cyber Extortion Event. Subject to the insurers policy wording.Telecommunications Fraud - Telecommunications Expenses due to a Computer Malicious Act or Malicious Use or Access of a Covered Telecom System by a Third Party, discovered by any Control Group member during the Policy Period. Subject to the insurers policy wording.Consumer Redress Fund - Sum of money that You are legally obligated to deposit in a fund as equitable relief for the payment of consumer Privacy and Network Security Claims or Media Claims due to an adverse judgment or settlement of a Regulatory Proceeding. Subject to the insurers policy wording.Payment Card Loss - Contractual liabilities owed to payment card industry firms because of a cyber incident. Subject to the insurers policy wording.Regulatory Fines - Defense for regulatory actions and coverage for fines and penalties, where insurable by law. Subject to the insurers policy wording.Ransomware - A type of malicious software designed to block access to a computer system until a sum of money is paidSocial Engineering Fraud - Direct Financial Loss solely as a result of Theft of Your Money or Securities due to Social Engineering Fraud by a Third Party and Discovered during the Policy Period. Subject to the insurers policy wording.
Previous Insurance
Do you currently hold an insurance policy *
Please provide the date your existing policy expires *

MonthDayYear
Date
Please select the name of the Insurer *
If Other Please put the Insurer *
Have you ever suffered any losses or claims**

YesNo
Have you ever had any insurance cancelled or declined or special terms imposed*

YesNo
Have you ever been charged or convicted of any criminal offence or declared bankrupt?*

YesNo
Are you aware of any matters not disclosed above that is relevant to the underwriters consideration of this insurance?*

YesNo
Please provide all relevant information to all questions answered "Yes" *
Contact Details
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Postal Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Postal code search*
How did you find us *
Please provide details *
Comments / Additional Information
Declaration*
Important Information
An Important Notice From the Insurer to the Applicant for ‘Claims Made’ Contracts of Insurance

Please read and retain in your file

The proposed insurance is issued on a ’claims made’ basis.

This means that the policy responds to:

1.Claims first made against the insured during the policy period and notified to CGU Professional Risks during that policy period, providing that the insured was not aware, at any time prior to the policy inception, of circumstances which would have alerted a reasonable person in the insured’s position that a claim may be made against the insured; and

claims circumstances’ notified pursuant to Section 40 (3) of the Insurance Contracts Act which states: ’where the insured gave notice in writing to the insurer of facts that might give rise to a claim against the insured as soon
as was reasonably practicable after the insured became aware of those facts but before the insurance cover provided by the contract expired, the insurer is not relieved of liability under the contract in respect of the claim, when made, by reason only that it was made after the expiration of the period of insurance cover provided by the contract’.

After policy expiry, no new claims can be made on the expired policy, even though the event giving rise to the claim may have occurred during the policy period.

If during the policy period you become aware of circumstances which a reasonable person in your position would consider may give rise to a claim, and which you fail to notify to us during the policy period, we may not cover you under a subsequent policy for any claim which arises from these circumstances.

When completing the Insurer Proposal you are obliged to report and provide full details of all circumstances of which you are aware and which a reasonable person in your position would consider may give rise to a claim.

It is important that you make proper disclosure (see Duty of Disclosure, below) so that your cover under any new policy with us is not compromised.

Pursuant to the Insurance Contracts Act your duty to disclose all relevant information is set out below

Duty of Disclosure

Before entering into a contract of general insurance, you have a duty, under the Insurance Contracts Act, to disclose to us every matter that you are aware of, or could reasonably be expected to be aware of, that is relevant to our decision about insuring you and if so, on what terms. You have the same duty to disclose these matters to us before you renew, extend, vary or reinstate a contract of general insurance.

Your duty however does not require disclosure of matter -
- that diminishes the risk to be undertaken by us;
- that is of common knowledge;
- that we know or, in the ordinary course of our business, ought to know;
- as to which compliance with your duty is waived by us
You should note that your duty continues after the Insurer Proposal has been completed until the policy is entered into.

Non-disclosure
If you fail to comply with your duty of disclosure, we may be entitled to reduce our liability under the policy in respect of a claim or may cancel the policy. If your non-disclosure is fraudulent, we may also have the option of avoiding the contract from its beginning. It is therefore vital that you enquire of all entities comprising the insured, including senior staff, before completing the Insurer Proposal and before you sign any declaration confirming no change in the information disclosed.

Retroactive Liability
The proposed insurance may be limited by a retroactive date either stated in the schedule or endorsed onto the policy. Where the retroactive cover provided by the proposed policy is subject to such a date, then the policy does not cover any claim arising from actual or alleged act, error, omission or conduct occurring prior to such retroactive date.

Average Provision
One of the insuring provisions of the proposed insurance may provide that where the amount required to dispose of a claim exceeds the limit of the sum insured in the policy then CGU Professional Risks shall be liable only for a proportion of the total costs and expenses. This shall be the same proportion of the total expenses as the policy limit bears to the total amount required to dispose of the claim.

Surrender or Waiver of any Right of Contribution or Indemnity
If another person or company is liable to compensate you or hold you harmless for part or all of any loss or damage otherwise covered by our policy, but you agree with that person or company (either before or after the inception of our policy) that you would not seek to recover any loss or damage from them, we will not cover you for this loss or damage.
* Mandatory Fields

Thank you for completing our online form.
We will endevour to contact you with your insurance details soon.
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CGIB Cyber Insurance Online Quote Form

Policy & Business Details

Client Security Officer Details

Underwriting Questions

Limits and Coverage

Please provide a breakdown of each state.

Coverage Required

Previous Insurance

Contact Details

Important Information