New Age Cyber Questionnaire - SterlingRisk Programs

Are You an Insurance Broker

YesNo

Broker Information

Broker Name

Email Address

Phone

Applicant Information

Contact Name

Email Address

Phone

Is Contact the owner?

YesNo

Owner Information

Owner Name

Owner Email Address

Business Information

Legal Entity Name

Annual Gross Revenue

Address Line 1

Address Line 2

City

State

Zip Code

Company Website

Business Classification

Type of Business

Protected Records

Do you Process or Maintain Healthcare Records?

YesNoProtected Healthcare Records means the total number of individuals for whom you store, process, or maintain records relating to healthcare informed.

Number of Healthcare Records

Do you Process or Maintain Personal Information Records?

YesNoProtected Personal Records means the total number of individuals for whom you store, process, or maintain financial account numbers or government identification numbers.

Number of Personal Information Records

Do you Process or Maintain Payment Card Transaction Records?

YesNoPayment Card Transactions means the total number of debit or credit card transactions that you process annually on transactions systems operated by you or others on your behalf if under your operational control.

Payment Card Transaction Records Annually

If credit card transactions occur, do you or your credit card vendor have current valid PCI compliance?

YesNo

Cyber Crime Prevention

Do you implement Multi-Factor Authentication (MFA) for all remote access?

YesNoN/AThis includes Microsoft Office (365), cloud data platforms, or physical/cloud servers.

Do you maintain offsite and/or cloud backups that are less than 1 month old?

YesNoN/A

Can you recover all of your business and critical data in less than 10 days?

YesNo

Prior Cyber Claims

In the past three (3) years, have you had any form of cyber incident including, but not limited to, a ransomware event, social engineering fraud, data theft, breach, or disclosure?

YesNo

Claim Information

How much did the loss cost including any damages, legal costs, IT costs, etc.?

Description (What Happened?):

What have you done since the event to prevent it from happening again?

Risk Management Change?

YesNo

BSP Cyber Solutions Questionnaire

BSP Cyber Solutions Questionnaire

800-767-7837

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