Technology E&O + Cyber Insurance Application

Step 1 of 8

Current and requested Technology E&O coverage

If you do not currently carry Technology E&O, leave the current-coverage fields blank or enter N/A.

Current carrier

Current limit

Retroactive or prior acts dateA date as shown on your current policy, if known. Not applicable or not known

Desired limit

Step 3 of 8

Technology products and services

Describe the Applicant's primary technology products and professional services

Primary type of technology work

Revenue by product or service

Up to 5. Percentages should total 100%.

The Applicant primarily serves

Businesses / organizations Consumers / individuals Government / public sector Mixed / other

Do customers pay the Applicant to customize, configure, implement, integrate, or develop technology solutions specifically for them?

Does the Applicant manufacture, sell, install, or maintain tangible technology products or hardware?

Does the Applicant provide hosting, cloud, infrastructure, or data-processing services to customers?

Does the Applicant or its personnel access, administer, support, or maintain customer systems, networks, applications, or data?

If helpful, briefly explain any Yes response above.

Step 4 of 8

Customers, contracts and E&O risk

Top customers (optional)

Up to 3.

Does the Applicant generally use written contracts, statements of work, purchase orders, or other written terms with customers?

Do contracts or project processes generally require customer acceptance, sign-off, or other confirmation that deliverables were completed?

Do the customer agreements generally include a limitation of liability?

Do they generally disclaim or limit consequential, special, or indirect damages?

Do they generally include indemnification or hold-harmless provisions that are mutual or benefit the Applicant?

Do they generally include warranty disclaimers or clearly defined warranties?

Are standard customer contracts, material changes, or non-standard agreements reviewed by legal counsel or General Counsel?

Does the Applicant use independent contractors or subcontractors to perform technology or professional services for customers?

Approximately what percentage of professional services work do they perform?

Intellectual property and media

Does the Applicant have a process intended to prevent infringement of third-party intellectual property rights?

Has the Applicant received a cease-and-desist letter or allegation of intellectual property infringement during the past three years?

Please explain

Step 5 of 8

Data privacy and cybersecurity

If you are unsure of a technical answer, choose Not sure. A specialist may follow up before markets are approached.

Approximate number of unique individuals whose PII, PHI or payment-card data is stored, processed or transmitted

Types of sensitive data handled (select all that apply)

Describe other sensitive data

Is sensitive information stored or processed by a cloud or third-party service provider?

Is sensitive information encrypted when appropriate (in transit and/or at rest)?

Is MFA required for remote access?

Is MFA required for email access?

Is MFA required for administrator or privileged accounts?

Is MFA required for critical systems and applications?

Does the Applicant use an email security or filtering tool for malicious links, attachments, phishing or impersonation?

Does the Applicant use endpoint protection (EDR, MDR, XDR or centrally monitored)?

Are business-critical systems and data regularly backed up?

How often are backups performed?

How are backups protected (offline, immutable, or segregated)?

Are critical security patches applied on a regular, documented basis?

Is cybersecurity or phishing awareness training provided at least annually?

Are payment-change requests independently verified by a separate communication method?

Does the Applicant have a business continuity and/or disaster recovery plan?

Is penetration testing performed at least annually?

Optional: describe security tools, vendors or practices you would like underwriters to know about

Step 6 of 8

Claims and known circumstances

During the past three years, has the Applicant experienced any Technology E&O / professional-services claim, cyber or security incident, privacy or data incident, regulatory matter, or media / intellectual-property claim?

Please describe what happened, when, any amount paid or reserved, and corrective measures taken

Is the Applicant currently aware of any fact, circumstance, error, complaint, security issue, or event that could reasonably be expected to result in a claim or loss?

Please explain

Step 7 of 8

Additional information

Additional informationAnything else that would help a specialist understand your business or coverage needs.

Step 8 of 8

Review and certify

Check your answers below. Use Edit to change anything before you submit.

The undersigned represents that, to the best of their knowledge and belief after reasonable inquiry, the information provided in this application is true, accurate, and complete. Completion of this application does not bind coverage. The Applicant agrees to notify its insurance representative of any material change in the information provided before coverage is bound.

Authorized representative name

Title

Email

Date

Typed signature

I agree

Technology E&O + Cyber insurance application

Company information

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