Welcome to Holman Insurance Brokers on-line Hacker / Cyber Theft Insurance quick quote page. Please ensure you complete the form as accurately as possible in order to ensure the best possible estimate. If you would rather speak to one of our sales representatives, please call us at (905) 886-5630 or 1-800-567-1279.

Completion of this form is for informational purposes only, and is just an estimate.
This WILL NOT result in a new policy, or change to an existing policy.

* Required Fields

Contact Information
Company Name*
Contact First Name*
Address*
Contact Last Name*
City*
Phone*
Province*
Phone 2
Postal Code*
Fax
Web Site
E-Mail*
Please specify your preferred method of contact:
Phone Email
Insurance Information
Are you presently insured? If yes, what company?* (enter "none" if answer is no)
Policy Number* (enter "none" if you do not have a policy number)
Expiry Date
What is your current annual premium?
$
Why are you looking for a new insurer or broker?
Company Information
Years in Business
Type of business
Describe the major business activities of the organization
As shown from the last Annual Statement or Report, please indicate:
Authorized Capital
Paid Up Capital
Total Sales Turnover
Pre-tax Profit
Computer and Data Environment
Does your organization use, store or process data on a mainframe computer?
Yes No
If yes, describe the manufacturer of the mainframe equipment (include equipment on order)
Operating Software for the mainframe equipment is:
Does your organization use, store or process data on a computer network?
Yes No
If yes, describe the type of networks currently in use:
How many computer users have access to the organization's computer system(s)?
How many computer user workstations are currently being used by your organization?
How many network computer servers are currently in use by your organization?
Describe your organization's geographic area as it relates to the location of computer hardware (mainframe, server, etc.)
Metropolitan area Regional area Province wide Multiple Provinces International
Are any of your computer systems connected to the internet or similar networks?
Yes No
If so, identify any external network connections:
Personnel and Computer Users
Are the computer systems and data accessed and used exclusively by company employees?
Yes No
Do customers have access to the system via a dedicated Customer Communication System?
Yes No
If yes, please indicate the number and nature of authorized access given to customers:
Do vendors or other external entities have access to the computer systems or data?
Yes No
If yes, please describe the number and nature of authorized external users:
Does the general public have access to the computer systems or data?
Yes No
If yes, please describe the number and nature of public access:
Do you outsource to a Service Bureau or other third party organization the performance of your data processing services or other computer systems services?
Yes No
If yes, please name the organization and describe the nature of the services:
Existing Computer System and Data Security measures
Does the organization have personnel dedicated solely to computer and data security?
Yes No
Does the organization utilize computer and data security software?
Yes No
Does the organization utilize anti-virus software?
Yes No
Does the organization utilize any firewall hardware or protocols?
Yes No
Coverage Information
What limits of insurance do you wish to purchase?
What level of deductible would you like? (minimum $2,500)
Do you purchase a commercial crime insurance?
Yes No
Does cover exist for theft using the computer system?
Yes No
Does cover exist for employee or partner theft using the computer system?
Yes No
What is the propsed inception date for coverage?
Claims (Please list all claims in past 5 years)
Location
Date of Claim
Claim Payout ($)
Nature of Loss
What steps have you taken to prevent against such loss in the future?
Additional Comments



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Hacker / Cyber Theft Quote