Cyber Quick Quote – Insured

First Light Program Managers does not sell direct to the public, but rather we distribute through a select group of retail brokers. Please complete the form below and we will have one of our retail brokers contact you.

Contact Name*
Enter your Contact Name
Contact Email*

Enter Contact Email
Contact Phone*
Please Enter your Phone Number
Insured Name*
Enter Insured Name
Address*
Please enter the full address for the main business to be used for all policy documentation.
Town or City*
Zip Code*
State*
Employees*
Please provide details of total number of full-time employees as of time of completing this application. Do not include the owner in this number if they are a sole proprietor.
Main Industry*
Please select the business description which most closely reflects the insured's main business activity. These activities are based on standard industrial classification codes.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Detailed Activity*
Please select the detailed activity that most closely matches the primary business activity.
Total Revenue*
Please enter the total revenue from the insured's last completed financial year. If this is the first year in business, then please enter an estimate for this year's revenue.
Privacy Liability Limit*
Please select the limit required for the privacy liability and cyber liability insuring clauses. Please note that this is a mandatory part of the cover.
Breach Notification Limit*
Please select the limit required for privacy breach notification costs. Please note this cover includes breach notification, legal advice about the notification, voluntary notification, credit monitoring and investigation costs. It is an optional aspect of cover.
Media Liability Limit*
Please select the limit required for the media liability insuring clauses. Please note this cover includes intellectual property rights infringement and defamation. It is an optional aspect of cover.
System Damage & Interruption Limit*
Please select the limit required for the system damage and business interruption insuring clauses. Please note this cover includes costs and expenses for repairing systems in the event of various cyber perils and also loss of revenue cover. It is an optional aspect of cover.
Cyber Crime Limit*
Please select the limit required for cyber crime. Please note this cover includes third party electronic crime including wire fraud, threats and extortion, telephone hacking and phishing scams.
Deductible*
Please select the desired level of self-insured retention for the policy.
Policy Inception Date*

Please enter the date you require the policy to start from. Please note that you cannot bind more than 30 days ahead and no back-dating is allowed.
Policy Period*
Is there more than one named insured? If yes, please provide the full name(s) and include a description of the operation and website address below.
Statement of Fact

Do you comply with all the requirements detailed within the Statement of Fact below? Please note that failure to comply with any of these requirements could result in your claim being repudiated by the insurers. *
- Yes
- No
- After full inquiry you are not aware of any circumstances, complaints, claims, loss or penalties/fines levied against you in the last five years, in relation to the risks that this application relates to.
- You have anti-virus software installed and enabled on all desktops, laptops and servers (excluding database servers) and it is updated on a regular basis. You also have firewalls installed on all external gateways. You take regular back-ups (at least weekly) of all critical data and store the same offsite or in a fire-proof safe or your outsourced service provider meets this requirement.
- You are not aware of any circumstances or complaints against you in relation to data protection or security, or any actual security violations or security breaches either currently or in the past five years.
- If you process or store credit card information (where this is not outsourced to a third party that accepts full responsibility for PCI compliance), you have been certified as being PCI compliant within the last 12 months or have successfully completed a self assessment audit.