Name* First Last Business Name*Email* Phone*WebsiteRisk QuestionsCompany IndustryState Head Office is Located in?*Please SelectAustralian Capital TerritoryNew South WalesVictoriaQueenslandSouth AustraliaWestern AustraliaTasmaniaNorthern TerritoryEstimated annual total of transactions and records?*Please Select0 - 1000010001 - 75000greater than 75000Estimated Turnover?*Please Selectup to 500,000500,000 - 1,000,0001,000,000 - 5,000,0005,000,001 - 10,000,00010,000,000+Are you Domiciled in Australia?* Yes No Are all mobile devices (such as laptops, tables, smartphones and memory sticks) password protected?* Yes No Are you aware of any matter that is reasonably likely to give rise to any loss or claim under such insurance, or have you suffered any loss or any claim including but not limited to a regulatory, governmental or administrative action brought against you, or any investigation or information request concerning any handling of personally identifiable information?* Yes No Are you compliant with the Payment Card Industry (PCI) Standards, or if not compliant, do you process, transmit or store LESS than 1,000,000 financial transactions or records containing an individual's personal information per year?* Yes No Don't Know Do you use operating systems with embedded firewalls and anti-virus protection software (such as Windows or MAC OS X), or run commercially licensed separate firewall or anti-virus protection software?* Yes No Don't Know Is more than 25% of your revenue derived from the USA or Canada?* Yes No Don't Know Where applicable, do you comply with The Privacy Act 1988 (Privacy Act)?* Yes No Not Applicable Has an independent party completed an audit of your system/data security?* Yes No Don't Know Do you have firewalls protecting your own and customer/client data?* Yes No Don't Know Are all mission/business critical systems and data information assets backed up and stored at another location?* Yes No Don't Know Do you protect all Personally Identifiable Information through Encryption?* Yes No Don't Know Do you have a data Protection/Privacy policy?* Yes No Don't Know Do you outsource the handling of any personally Indentifiable Information?* Yes No Don't Know Captcha
