Cyber Insurance Questionnaire

Protect yourself from the traditional insurance company denying your claims and raising your premiums

GET A QUOTE

By filling out this questionnaire SeCAP Inc. will provide your company with a no-cost external discovery as mapped to NIST 2.0 ($15,000.00 value). The information provided also allows for SeCAP Inc. to provide an initial quote for the insurance coverage and policies you desire without going through an interview process. SeCAP Inc. understands by requesting this information we are held to high degree of security and we take that obligation seriously. In order to further protect your information, SeCAP Inc. has expressly taken out any requests for information that bad actors may deem profitable; while, at the same time allowing for a framework to establish coverage quoting.

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Step 1 of 3

General Information

Business Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Description of Operations:

Company Website:

Company Phone Number:

Fiscal Year End:

Primary Contact

First

Last

Primary Contact Phone Number:

Primary Contact Email Address:

General Information

Corporate Structure

Additional information about employer Sponsored health and/or Benefit PlansSection Divider

Policy Information

Worker Compensation (copy)

General Liability

Auto Liability

Property

Personal Liability

Cyber Liability

Directors & Officers Liability

Employment Practices Liability