This is a proposal form for a contract of insurance. Within this form, ‘proposer’ means the individual, company, partnership, limited liability partnership, organisation or association requesting insurance.

All questions with an asterisk (*) must be answered to enable a quotation to be provided, however completion of these questions does not bind you or the insurer to enter into a contract of insurance.

You should retain a copy of the completed proposal (and of any other supporting information) for future reference.

You have a duty to make a fair presentation of the risk to be insured by clearly disclosing all material circumstances which you, your senior management and those responsible for arranging this insurance know, or ought to know, following a reasonable search of the information that is available. Failure to do so may make the contract of insurance voidable or severely prejudice your rights in the event of a claim.

A circumstance is material if it would influence the judgement of a prudent insurer in determining whether to take the risk and, if so, on what terms. If you are in doubt as to whether a circumstance is material, please contact us to discuss this further.

  • DD slash MM slash YYYY
  • DD slash MM slash YYYY

  • Key Details

  • Please confirm that:

  • Cover Options

  • (For all computer expert services, legal services and public relations and crisis management services combined)
  • (select the ‘maximum’ number of individuals whereby notification of a data breach would be required)
    (First Party Network Business Interruption loss covered up to full policy limit and will be applicable to: Forensic Sublimit, and Dependent Business Interruption Sublimit)
  • First Party Loss

    To indemnify the Insured Organisation for:

    • Business Interruption Loss

      • Business Interruption Loss that the Insured Organisation sustains as a result of a Security Breach or System Failure that the Insured first discovers during the Policy Period.

    • Dependent Business Interruption Loss

      • Dependent Business Loss that the Insured Organisation sustains as a result of a Dependent Security Breach or a Dependent System Failure that the Insured first discovers during the Policy Period.

    • Cyber Extortion Loss

      • Cyber Extortion Loss that the Insured Organisation incurs as a result of an Extortion Threat first made against the Insured Organisation during the Policy Period.

    • Data Recovery Costs

      • Data Recovery Costs that the Insured Organisation incurs as a direct result of a Security Breach that the Insured first discovers during the Policy Period.

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