Cybersecurity Insurance Requirements Questionnaire
Complete this form to help us understand your organization's cybersecurity insurance needs and exposures. All questions are designed to ensure a tailored assessment.
Organization Name
*
Contact Email
*
example@example.com
Industry
*
Please Select
Technology
Healthcare
Finance
Retail/E-commerce
Education
Manufacturing
Professional Services
Other
Number of Employees
*
Please Select
1-10
11-50
51-200
201-500
501-1000
1001+
Annual Revenue Range (USD)
*
Please Select
Under $1 million
$1 million - $10 million
$10 million - $50 million
$50 million - $250 million
Over $250 million
Which of the following cybersecurity measures are in place?
*
Multi-factor authentication
Regular security awareness training
Endpoint protection (antivirus/EDR)
Firewall
Regular data backups
Incident response plan
None of the above
Has your organization experienced a cyber incident in the past 3 years?
*
Yes
No
Not Sure
Types of data your organization handles (select all that apply)
*
Customer personal data (names, emails, addresses)
Payment or transaction data
Health or medical data
Employee personal data
Intellectual property
Other sensitive data
None of the above
Does your organization currently have cybersecurity insurance?
*
Yes
No
Not Sure
Please describe any specific cybersecurity concerns or requirements.
Submit
Should be Empty: