If you prefer to talk to a broker first, call
1300-881-779 between 8.15am and 5.15pm E.S.T. business days and receive an indicative quote over the phone.
Website address (if applicable)
ABN No: Put "TBA" if not known
Please provide a description your business activities:
Do you use anti-virus protection software?
Are all mobile devices (such as laptops, tablets, smart phones and memory sticks) password protected?
Do you outsource any part of your network, including storage?
Are you aware of any matter that is reasonably likely to give rise to any loss or claim under such
insurance, or have you suffered any loss or any claim including but not limited to a regulatory,
governmental or administrative action brought against you, or any investigation or information request
concerning any handling of personally identifiable information?
By submitting this Declaration, the Applicant acknowledges:
Name of person making this declaration: