| Contact Information Part A, Page 1 |
|
| Full Name of Applicant |
Jon Smith |
| Applicant Type |
Individual |
| If, other |
|
| Address |
22 First Avenue |
| Address 2 |
Apt B |
| City |
NY |
| State/Province |
NY |
| Country |
USA |
| Zip/Postal Code |
02110 |
| Web Site Home Page URL |
Yahoo.com |
| Date Established |
|
| Place of Incorporation |
|
| Are you the insurance broker for the applicant? |
No |
| Is your contact person a broker? |
Yes |
|
[Top]
|
|
| Broker Contact Information Part A, Page 1a |
|
| Last Name |
Smith |
| First Name |
Steve |
| Company Name |
KPMG |
| Address |
22 First Ave |
| Address 2 |
Apt 6 |
| City |
NY |
| State/Province |
NY |
| Zip/Postal Code |
02110 |
| Phone |
212-222-3333 |
| Email |
jsmith@hotmail.com |
| License Number |
1112293-99493 |
|
[Top]
|
|
| Coverage Analysis Part A, Page 2 |
|
| Do you have a Web site? |
Yes |
| Do you provide Internet professional services (such as publishing,financial,technology or consulting) and/or render professional services over the internet? |
Yes |
| Do you obtain revenue from goods or services that you sell over the internet? |
Yes |
| Do you store customer, company, or other types of information electronically? |
Yes |
| Do you have a reward system in place to catch a cyber criminal? |
Yes |
| Do you have a cyber-crisis communication plan for your company and is there a budget in place to support it? |
Yes |
|
[Top]
|
|
| Coverage Analysis Continued Part A, Page 3 |
|
| Business Activities On the Internet/Network |
Access,Presence,Production Access |
| Next Year: The following business activities planned are different than the ones checked above? |
Electronic Commerce,Hosting,Digital Certification,Other |
| Business Revenues |
|
| 1.Total Revenues |
|
| Past Accounting Year (USD) |
$$$$$$$$$ |
| Projected Current Year (USD) |
$$$$$$$$$ |
| 2. Total eBusiness Revenues (if applicable) |
|
| Past Accounting Year (USD) |
$$$$$$$$$ |
| Projected Current Year (USD) |
$$$$$$$$$ |
| Number of unique visitors per day (USD) |
xxxxxxxx |
|
[Top]
|
|
| Coverage Confirmation Part A, Page 4 |
|
| Coverage for liability arising from the content of your web site, such as copyright and trademark infringement, libel and slander. |
Yes |
| Coverage for acts, errors and omissions in the rendering of professional services. |
Yes |
| First party coverage for network security caused business interruption loss of internet revenue |
Yes |
| First party coverage for network security caused damage or destruction information date |
Yes |
| Coverage for up to $50,000 in cyber-criminal reward funds |
Yes |
| Coverage for up to $50,000 in cyber-crisis communication reimbursement |
Yes |
| Coverage for cyber-extortion threats |
Yes |
|
[Top]
|
|
|
 |
