Financial Crime Application Email for non-humansGeneral InformationGeneral Information Applicant(s)(all trade names & Insureds): *Address *City *State *- Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip *Is Applicant a(n): (check all that apply)Is Applicant a(n):(check all that apply) Title Agency - Title Agency Year Operations BeganAttorney / Law Firm - Attorney / Law Firm Year Operations BeganAny Crime losses known or reported in the past 3 years? * Yes NoPlease list the names of all Owners *(If “Yes”, provide explanation)Number of Owners, Officers or Employees who handle, have custody of, maintain financial records of or have access to money of Applicant or others: *Do the people noted in the previous question have MORE than 3 years’ experience? * Yes NoScope of Financial Statement preparationInternalCPA CompilationCPA ReviewCPA AuditNoneDoes Applicant have current Cyber/Data Breach coverage? * Yes NoCoverage RequestedCoverage Requested Does Applicant have current Crime coverage? * Yes NoIf “Yes”, provide info:If “Yes”, provide info: CarrierLimit: $Expiration Date:Which Coverage(s) does Applicant want? (check all that apply)Limits: *Deductible is 1% of Limits $250,000 $500,000 Employee Dishonesty Employee Dishonesty - Loss directly from dishonest acts commited by an employee (Insuring Agreement 1) Forgery or Alteration Forgery or Alteration - Loss directly from forgery or alteration of checks, etc. (Insuring Agreement 2) Computer Hacking Computer Hacking - Loss directly from Applicant or Financial Institution computer transferring money (Insuring Agreement 3) Counterfeit Payments Counterfeit Payments - Loss directly from acceptance of counterfeit payments (Insuring Agreement 4) Funds Transfer Fraud Funds Transfer Fraud - Loss directly from internal fraudulent instruction (Insuring Agreement 5) Fraudulently Induced Transfer Forgery or Alteration - Loss directly from external fraudulently induced transfer (Insuring Agreement 6) OperationsOperations Does Applicant deposit and disburse funds for Closing & Settlement? * Yes NoAre funds deposited in a trust account separate from any operating account? * Yes NoWhat is the average daily escrow (trust) account balance? *$Does the file contain loan closing & documentation of compliance with funding/disbursement instructions? * Yes NoAre all escrow (trust) funds reconciled on a monthly basis? * Yes NoIf “Yes”, how are discrepancies handled/cleared?Is Applicant periodically audited by the title companies they represent? * Yes NoWhat verification or review is performed at time of Employee hiring? (check all that apply) * Prior employment verification Drug testing Education verification Credit history/report Criminal history Are bank accounts reconciled and controlled by the: (check all that apply) * Owner Employee If “Employee was checked, check the items where their work is reviewed: Deposits Check signing for Trust accounts Check initiation & Check disbursement Withdrawals Check signing for Operating accounts Reconciliation Does any Employee have authority to execute a wire transfer? * Yes NoA. If “Yes”, is it limited to a specific Employee? Yes NoB. If “Yes”, allow wires outside the USA? Yes NoIf “Yes” to either of the last 2 questions, can one Employee control either process from beginning to end? Yes NoIf one Employee has full control, explain how you oversee them to prevent/discover misuse?How do you verify the identity of clients/customers? (check all that apply) * Verify using vendor In Person Photo ID Other Client Referral Other Not Verified / None Other: (describe)Does Applicant use multi-factor authentication (MFA) to access their computer systems? * Yes NoDoes Applicant use SPAM and Phisihing protection on their email server(s)? * Yes No N/A (no in-house email server)Do Applicant’s computers, servers and portable devices contain the following: (check all that apply) * Firewall protection Spoofing protection Anti-Virus software Software to encrypt any stored personal information Malware protection Does Applicant provide ongoing training to all Employees to identify, prevent & respond to fraud, social engineering, phishing, masquerading or other fraud schemes? * Yes NoWire Handling / ProceduresWire Handling / Procedures There is no coverage under IA 6 if Applicant does not follow their internal wire procedures or does not verify/document verification of wiring information/instructions. Does Applicant have a written policy or procedures regarding wire transfers? * Yes NoApplicant’s average daily $ amount of wire transfers? *$Applicant’s average monthly number of fund transfers? *Per MonthHow does Applicant verify internal funds transfer instruction from employees, officers or owners? (check all that apply) * Telephone Email Text message Other Other: (describe)How does Applicant accept external funds transfer instructions from clients/customers? (check all that apply) * Telephone Email Text message Other Other: (describe)What written procedures are used to authenticate funds transfer instructions received by methods chosen in the previous question? (check all that apply) * Call predetermined number Text predetermined number Require secret code or other info known only to client to confirm identity Transfers over $10k are authorized & verified by 2 Employees prior to execution Submit
