Cyber Liability Insurance Worksheet

Cyber Liability Insurance Worksheet

UWIB
Welcome to UWIB. If you'll take a couple of minutes to empower us, we'll quickly respond with your personalized proposal for Cyber Liability coverage.

We work with seven of the leading Cyber coverage carriers. Each provides FREE cyber threat tools for policyholders.

If you get stuck on a question, just give us a call at 800-378-5554 or an email at helpdesk@uwib.com

Cyber Liability insurance is different than traditional coverage. Cyber Crime is a growing threat to all of us.
Let's Get Started
Is a contractual requirement one of the reasons you want a quote?*

NoYes
What do you project your company’s total sales will be over the next year?*
Approximately how many people work at your company?
Describe what your company does or provide the SIC code if that’s easier (you can copy the link under the entry field and find your Industry Classification Code*
Find your SIC Code https://www.osha.gov/data/sic-search
Please mark any that may apply or select None apply

Suffered a data breach requiring you to notify individuals of the breach?Physically lost a computer, hard drive, laptop, or smartphon that had sensitive information on it?Been hacked or discovered that an unauthorized person had gained access to one of your systems?Has any third party either individually or through a regularitory organization notified you that data may have become exposed?None of these apply
Mark all that might live in your company’s data even if only for your own employees or former employees (most companies mark several of these)*

Social Security NumbersBank Account NumbersProtected Health InformationDriver's License/Passport NumbersEducational RecordsGovernment/Tax ID NumbersCredit History/Reports/RatingsIntellectual PropertyUserID & PasswordsEmail AddressesFinancial Reports/RecordsBackground Check InformationDate of BirthMothers Maiden NameNone of the above
Please estimate how many of those records exist in your database?

Zero to 100,000100,000 to 500,000500,000 to 1,000,000More
If you accept credit cards, do you and the processing company comply with the Payment Card Industry Data Security Standard (PCI-DSS)?*

YesNoNot Applicable - we don’t accept credit card payments
Do you occasionally conduct system intrusion and vulnerability testing?*

YesNo
Do you already have Cyber coverage?*

NoYes
Current policy's Expiration Date:*
If you don’t have a policy just say N/A
Have you made any prior Cyber claims?*

YesNo
Are you aware of any current threat of a possible claim?*

YesNo
Your company’s name*
Organization's Federal Tax ID Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Name

First NameLast Name
Your Cell #

Area CodePhone Number
Your Email
example@example.com
This worksheet doesn't bind you or us, but it constitutes the information that we'll use to provide the proposals we build for you. Coverage can't be bound until the insurance carrier has given approval in writing, and a premium deposit has been paid by you.

Getting a proposal does not commit you to purchase and does not incur any cost to you. If you wish to proceed, please submit the information to us now.
Today's Date

MonthDayYear
Should be Empty: