• Crypto Smart

    Specialised coverages tailored to the cryptocurrency and blockchain industry, ensuring comprehensive protection against key risks.

  • Broker Information

  • Format: (000) 000-0000.

  • Applicant & Business Profile

  • Date Established
     - -
    4 digit year, 2 digit month, 2 digit day
  • Licensed to conduct business activities in all operating jurisdictions?
  • Do you require the following types of coverage?

  • Historical and Projected Financials

  • Financial Details
    Rows

  • Operational Changes & Record Counts

  • Have there been any significant changes in operations in the past 12 months?

  • Vendors, Service Providers & Business Mix

  • Business Activities and % of Total Revenue

  • Cyber Security, IT Governance & Controls

  • Have there been material changes to cyber security governance and data controls?
  • Structure of IT Operations
    Rows
  • Have there been material changes to IT Asset Management controls?
  • Use of end-of-life (unsupported or legacy) software or hardware
  • If using end-of-life systems, are they segmented or air-gapped?
  • Have there been material changes to MFA, privileged access, and email security controls
  • Have there been any material changes to your security tools and controls implemented within the cloud, IT and/or OT infrastructure?

  • Business Continuity, Backup & Privacy

  • Have there been any material changes to your backup controls, policies, and procedures?
  • Backups restoration and recovery tested in last 6 months
  • Have there been any material changes to your privacy controls, policies, and procedures?
  • Use of trackers, web beacons, or pixels on website
  • If trackers are used, is collected user data minimized and legally compliant?
  • Have there been any material changes to your funds transfer fraud controls, policies, and procedures?
  • Dual authorization required for financial transactions above $50,000 CAD?

  • Technology E&O Insurance

  • Client Contracts: Provide details on at least the four (4) largest client contracts commenced over the last twelve (12) months
  • Do you host or store sensitive information or assets for clients? (e.g., credit card information, cryptocurrency, digital wallet private key information, medical records, financial transaction records, etc.)
  • Contractual Content & Procedures: Have there been any material changes to your risk-mitigation measures contained in your contracts or Terms of Service with clients and users?
  • Are written contracts always in place for all Independent Contractor engagements?
  • Software Development & Quality Controls: Have there been any material changes to your software development and quality controls, policies, and procedures?

  • Media Content Insurance

  • Media & Intellectual Property (IP) Liability Exposures: Select the media activities and services you conduct (traditional, digital, or online):
  • Fill in the percentage of printed, broadcast, published, or distributed content by source:
    Rows
  • Media & Intellectual Property (IP) Liability Management: Have there been any material changes to your media and IP liability controls, policies, and procedures?

  • Emerging Technology Activities

    Please Note: Only complete the sections applicable to your business operations. Leaving unanswered will constitute no exposure to the emerging technology

  • Blockchain Smart Contracts

  • Select all smart contract controls currently implemented:
  • Is the code for your smart contracts maintained in a public or private repository?
  • Do contractual obligations or indemnification agreements exist that expose you to a liabilityif a smart contract failure occurred?

  • Digital Asset Hot Wallet Storage

  • What percentage of employees and other authorized personnel can access your hot wallets?
  • Select all hot wallet storage controls currently implemented:

  • Artificial Intelligence (AI)

  • What percentage of employees and other authorized personnel can access your hot wallets?
  • Select all AI controls currently implemented:
  • Does your AI system collect any protected data (e.g., PII, PHI, PCI)?
  • Do you use third-party AI systems within your organization or products/services?

  • E-Gaming (E-Games of Chance, E-Games of Skill, & E-Sports)

  • State the percentage of users attributed to the following business model(s):
    Rows
  • Do algorithms influence gaming outcomes or monetary wins or losses?
  • Select all e-gaming controls currently implemented:

  • Directors & Officers Liability

    Please complete if coverage is required
  • Details of Subsidiaries: Please give details of any subsidiaries to be included in this insurance:
  • Is cover required for such outside board positions?

  • Crime Coverage Section

    Please complete if coverage is required.
  • Details of Ownership: Please state the number of:
    Rows
  • Is there a central corporate communications policy in place and is the attention of all employeesdrawn to it?
  • Are full employee references taken out for all employees without exception?
  • Are duties of each employee arranged so that no one employee is permitted to control anytransaction from commencement to completion?
  • Is there an internal audit team that performs independent checks in the controls and procedures in place in each entity intended to be covered by our Certificate of insurance?
  • Have all material recommendations made by internal/external auditors in the last five years been implemented?
  • Do lawyers (either internal or external ) review the prospectus for each Fund?
  • Is the responsibility for investment decisions segregated from the accounting, back-office and custodial responsibilities?
  • Are wages/salaries independently checked against personnel records for unusual or excessivepayments?
  • Are wages/salaries independently checked against personnel records for unusual or excessivepayments?
  • Are the following duties segregated so that no individual can control them from commencement to completion without referral to others: Signing cheques or authorizing payments above CAD 10,000 (or currency equivalent)
  • Are the following duties segregated so that no individual can control them from commencement to completion without referral to others: Issuing fund transfer instructions
  • Are the following duties segregated so that no individual can control them from commencement to completion without referral to others: Amending funds transfer procedures
  • Are bank statements independently reconciled by persons not authorized to deposit/withdraw funds or to issue funds transfer instructions?
  • Does the Applicant have set procedures in place to ensure any unauthorized or trading errors are identified, monitored and where necessary rectified?
  • Does the Applicant have set procedures in place to ensure any breaches of pre-agreed investment restrictions are recognized and rectified?
  • Does the Proposer have set procedures in place to ensure a formalized due diligence process is followed when assessing any given investment or investment strategy?
  • Does the Proposer have set procedures in place to ensure regulatory requirements, provisions, rules, principles and codes are adhered to by all relevant employees?
  • Are unique passwords used to give various levels of entry to the computer depending onthe users authorization and/or authority level?
  • Are passwords automatically withdrawn when people leave?
  • Are all amendments to in-house programs approved independently of the person making the amendments?
  • Is your computer system protected by virus detection and repair software?

  • Facts & Circumstances

  • Are you aware of any fact, circumstance, transaction, event, threat, act, error, omission, misstatement, misleading statement, neglect, or breach of duty which could give rise to an event, loss, or claim that would fall within the scope of the Policy for which you are applying
  • Does the company currently have insurance for Directors and Officers Liability?
  • Has an insurer ever cancelled, refused to accept or renew any Directors and Officers insurance forthe company, or imposed special conditions?
  • During the last five years has the company made any claim under a Directors and OfficersLiability policy?
  • Has the company, its directors or officers been involved in any antitrust, copyright or patent litigation?
  • Has the company, its directors or officers been involved in any civil or criminal action or administrative proceeding alleging a violation of any laws relating to the sale or purchase of any shares, investments or securities?
  • Has the company, its directors or officers been involved in any representative actions, class actions or derivative suits?
  • Are there any pending claims against anyone who will be covered under this insurance, which may fall within the scope of coverage afforded by any similar insurance currently or previously inforce?
  • Has anyone who will be covered under this insurance given notice under the provisions of any other similar current or previous insurance of any facts or circumstances which may give rise to a claim being made against the company and/or any director or officer?
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  • Please add all Subsidiaries

  • Declaration

  • Format: (000) 000-0000.
  • Should be Empty: