Cyber Insurance - HIFA Insurance Brokers

Legal name

Operating name (if any)

Address

Street address

Unit#, etc.

City

Province

Postal code

Main phone

Main email

Website

Legal entity:

Sole proprietorship

Partnership

Incorporation

Other

Other legal entity:

Contact person details:

First name

Last name

Contact person's phone no.

Contact person's email

Cyber insurance details:

Current insurance company name (if applicable)

Current insurance policy number (if applicable)

Effective/renewal date

If renewal was not being offered, please explain.

Have you had a personal data breach, other security breach or other cyber related incident (such as loss of money) in the past 3 years that would have or could have led to a claim or notification under any of these cyber covers had they been in place at the time? If yes, please state the total cost and details:

Have you been subject to legal or regulatory action in relation to data privacy in the past 3 years? If yes, please state the total cost and details:

Have you ever received any complaint or claim about personal or confidential data? If yes, please state the details:

If you answered yes to any of the three question above, please provide details of any measures, including professional advice, that have been taken to prevent the recurrence of the situation which gave rise to each claim.

Please provide a full description of the business activities including any subsidiary or associated companies to be covered.

Have you ever had any cyber insurance declined, cancelled or withdrawn? if yes, please state the details:

Contact person details:

Cyber insurance details:

Cyber risk assessment:

Please provide the best estimated values for the following: If N/A, then enter 0

a) Canada

b) US

c) Others

Finding exactly the right insurance coverage is not a daunting process at HIFA. We’ll make it straightforward and hassle-free so you’ll know exactly what you’re getting and can feel confident that you have the right coverage.