Online Quoting

Agency Information

Insured Information

(Enter gross revenue for the last fully completed financial year [or your good faith estimate of this year's gross revenues if insured is a start-up] not to exceed $100,000,000.)

Please answer "Yes" (being true) or "No" (being false) to the following statements:

2) Insured transacts no more than 1,000,000 payment card transactions annually. YesNo

3) Insured stores, at any one time, no more than 1,000,000 records containing Personally Identifiable Information. YesNo

4) All laptops and tablet computers are encrypted. YesNo (If you answered "Yes" skip to item #6.)

5) If you answered "No" in the previous item, are any laptops and tablet computers storing Personally Identifiable Information*? YesNo

6) Insured has either confirmed it is compliant with or confirmed it is not subject to the Payment Card Industry Data Security Standards (PCI/DSS). YesNo

7) Insured is not aware of any matter that is reasonably likely to give rise to any First Party Loss* or Claim*, nor has the insured suffered any First Party Loss*, nor has any Claim* been made against the insured in the last five years. YesNo

8) No regulatory, governmental, or administrative action has been brought against the insured, nor any investigation or information request, concerning any handling of Personally Identifiable Information. YesNo