CYBER APPLICATION (Please complete ALL questions)

Owner(s) Full Legal Name:
Date of Birth:
Address / Postal Code:
Occupation:
Email:
Phone:
How did you hear about us:

Technical Assessment:

Do you have antivirus software insurance installed on your computer system? YesNo
Have the passwords on your computer system and connected home devices been changed from the default password that existed on the computer system or home devices?YesNo

Claims:

Have you had any claims or circumstances of cyber-attacks, cyber extortion threats, identity theft, credit card fraud, phishing, or other liability or property claims or financial losses within the past 5 years?YesNo

If yes, how many have you had?
Please describe the incident(s)
Are you aware of any cyber-attacks, cyber extortion threats, identity theft, credit card fraud, phishing attempts in the last 30 days? YesNo

Aggregate Limit Required

$25,000$50,000$100,000$250,000$500,000

Cyber Bullying extension? YesNo

Cyber Bullying Expenses

reasonable expenses that insured or family member incur the cost of up to 20 hours of psychiatric services, professional digital forensic analysis, professional cyber security consultant service, professional public relations consultant

Cyber Bullying Events

means a series of three or more similar or related acts by the same person or group of persons that are
intended to intimidate, harass, humiliate or defame that are committed against insured or family member

Please note: Coverage is not considered bound until you have received confirmation from a licensed broker.

Your Privacy and Email Consent

We are committed to protecting your personal information and take all reasonable steps to keep it secure. However, email is not always a fully secure method of communication. There is a risk that messages may be intercepted, viewed, or stored outside of Canada depending on your email provider. We recommend deleting insurance-related emails after reviewing them to help reduce that risk.

I understand and accept the risks of communicating by email.* Yes