Cyber Application Email for non-humansGeneral InformationGeneral Information Applicant Name *Applicant Contact Name *Applicant Contact Title *Physical Address *Physical Address Line 2City *State *- Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip *Mailing address is same as billing address Mailing address is same as billing address Mailing AddressMailing Address Line 2CityState- Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZipEmail Address *WebsitePhone Number *Include extension, if applicableFax NumberOfficers & OwnersOfficers & Owners Officer/Owner Block 1 Name * Age Title Ownership % * Active in Daily Business? Yes No 1 Name * Age Title Ownership % * Active in Daily Business? Yes No Add Officer/Owner Total Ownership %RevenuesRevenues 12-month Gross Revenues *Your retained commission after paying underwriters plus revenue/fees from closing, escrow, or title searches.$Cyber Threat ProtectionCyber Threat Protection Any “No” responses will require an explanation. Is data backed up on a regular basis? * Yes NoExplain your "No" Response *Are anti-virus and firewall systems in place and updated on a regular basis (at least quarterly)? * Yes NoExplain your "No" Response *Are mandatory individual, unique, non-trivial IDs and passwords utilized for all devices? * Yes NoExplain your "No" Response *Are all laptops, computers, and mobile devices storing Personally Identifiable Information (PII) encrypted? * Yes NoExplain your "No" Response *Can you confirm that the applicant does not accept any credit card transactions which are not processed by a payment processor? * Yes NoExplain your "No" Response *Are the number of unique PII / Personal Health Information records less than 500,000 (1,000,000 if revenues are in excess of $5,000,000) * Yes NoExplain your "No" Response *Can you confirm that the applicant has not sustained a system intrusion, tampering, virus, or malicious code attack, loss of data, hacking incident, data theft, or similar incident within the past 5 years? * Yes NoExplain your "No" Response *Can you confirm that no person has alleged that their confidential information has been compromised? * Yes NoExplain your "No" Response *Can you confirm that the applicant has not sustained any unscheduled network outage or interruption in the past 24 months, except where the outage has been caused by natural events (storms, tornadoes, etc.)? * Yes NoExplain your "No" Response *Can you confirm that the applicant has not experienced any claims or losses, or are aware of any circumstances that could give rise to a claim or loss that may have been covered by this policy? * Yes NoExplain your "No" Response *Submit