Basic Company Details
Please complete the following details for the entire company or group (including all subsidiaries) that is applying for the insurance policy:
Are you an existing Tripemco client?
Company Name
Primary Address
Contact Name
Position
Email Address
Telephone Number
Description of Business Activities
Website Address
Date Established (YYYY-MM-DD)
Number of Employees
Last 12 Months Gross Revenue
Revenue From US Sales
Last 12 Months Gross Profit
Please State Which Financial Institution(s) You Use for Your Commercial Banking
Please provide the following details for your top 5 clients (Client Name, Primary Services, and Annual Revenue)
Basic Risk Questions
Please confirm whether multi-factor authentication is always enabled on all email accounts for remote access. (Select one)
Do you maintain daily offline back-ups of all critical data?
Please confirm the name of your Managed Service Provider (if applicable):
Is any part of your IT infrastructure outsourced to third party technology providers, including application service providers?
If you answered yes to the question above, please list your most critical third party technology providers (up to a maximum of 10):
Previous Cyber Incidents
If you ticked any of the boxes above, did the incident(s) have a direct financial impact upon your business of more than $10,000?
If ‘yes’, please provide more information below, including details of the financial impact and measures taken to prevent the incident from occurring:
IT Resourcing and Infrastructure
What was your approximate operational expenditure on IT security in the last financial year? (Including salaries, annual licenses, consultancy costs, etc.)
What was your approximate capital expenditure on IT security in the last financial year? (Including hardware, one-off software costs, etc.)
Do you anticipate spending more, the same, or less in this financial year?
Is your IT infrastructure primarily operated and managed in-house or outsourced?
How many full-time employees do you have in your IT department?
How many of these employees are dedicated to a role in IT security?
Additional information you would like to share.
Information Security Governance
Who is responsible for IT security within your organization (by job title)?
How many years have they been in this position within your company?
Please describe the type, nature and volume of the data stored on your network, including a rough estimate of the total volume of unique individuals you hold data on:
Please describe your data retention policy, including details of how often you purge records that are no longer required:
Please describe your data back-up policy in detail, including the frequency of back-ups, the technology used, the types of back-ups, the storage method used (online or offline), how often you test the back-ups and how you protect your back-ups:
Do you comply with any internationally recognized standards for information governance (if yes, which ones):
Cyber Security Controls
If your organization uses Remote Desktop Protocol (RDP) to allow remote access to your network, please describe the measures you adopt to secure it:
Please describe your process for patching all operating systems and applications:
How often do you conduct vulnerability scanning of your network perimeter?
How often do you conduct penetration testing of your network architecture?
Please provide details of the third party providers you use to conduct penetration testing:
Please provide the name of the software or service provider that you use for each of the controls highlighted above:
Important Notice
By signing this form you agree that the information provided is both accurate and complete and that you have made all reasonable attempts to ensure this is the case by asking the appropriate people within your business. Tripemco Insurance Group will use this information solely for the purposes of providing insurance services and may share your data with third parties in order to do this. We may also use anonymized elements of your data for the analysis of industry trends and to provide benchmarking data. For full details on our privacy policy please visit
tripemco.com/privacy-policy
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