Phishield Cyber Protect Business Policy Proposal Company Name:(Required) Type Of Entity:(Required) Private Public Company Close Corporation Sole Proprieter Partnership Trust Registration Number: Physical Address:(Required)Contact Number(Required)Contact Person(Required) First Last Email Address:(Required) Number Of Employees:(Required) Annual Turnover (choose a range):(Required)R0 to R10 000 000R10 000 001 to R25 000 000R25 000 001 to R50 000 000R50 000 001 to R75 000 000R75 000 001 to R100 000 000R100 000 001 to R150 000 000R150 000 001 to R200 000 000Industry And Sub-industry:(Required) Agriculture, Forestry, And Fishing Mining Construction Manufacturing Transportation, Communications, Electric, Gas, And Sanitary Services Wholesale Trade Retail Trade Finance, Insurance, And Real Estate Services Public Administration Choose Subindustry(Required)Agriculture production livestock and animal specialtiesAgricultural ServicesForestryFishing hunting and trappingAgricultural Production CropsChoose Subindustry(Required)Metal MiningCoal MiningOil And Gas ExtractionMining And Quarrying Of Non-metallic Minerals, Except FuelsChoose Subindustry(Required)Building Construction General Contractors And Operative BuildersHeavy Construction Other Than Building Construction ContractorsConstruction Special Trade ContractorsChoose Subindustry(Required)Food And Kindred ProductsTobacco ProductsTextile Mill ProductsApparel And Other Finished Products Made From Fabrics And Similar MaterialsLumber And Wood Products, Except FurnitureFurniture And FixturesPaper And Allied ProductsPrinting, Publishing, And Allied IndustriesChemicals And Allied ProductsPetroleum Refining And Related IndustriesRubber And Miscellaneous Plastics ProductsLeather And Leather ProductsStone, Clay, Glass, And Concrete ProductsPrimary Metal IndustriesFabricated Metal Products, Except Machinery And Transportation EquipmentIndustrial And Commercial Machinery And Computer EquipmentElectronic And Other Electrical Equipment And Components, Except Computer EquipmentMeasuring, Analysing, And Controlling Instruments; Photographic, Medical And Optical Goods; Watches And ClocksMiscellaneous Manufacturing IndustriesChoose Subindustry(Required)Railroad TransportationLocal And Suburban Transit And Interurban Highway Passenger TransportationMotor Freight Transportation And WarehousingPostal ServiceWater TransportationTransportation By AirTransportation ServicesPipelines, Except Natural GasCommunicationsElectric, Gas, And Sanitary ServicesWater and Waste ManagementChoose Subindustry(Required)Wholesale Trade-durable GoodsWholesale Trade-non-durable GoodsChoose Subindustry(Required)eCommerceBuilding Materials, Hardware, Garden Supply, And Mobile Home DealersGeneral Merchandise StoresFood StoresAutomotive Dealers And Gasoline Service StationsApparel And Accessory StoresHome Furniture, Furnishings, And Equipment StoresEating And Drinking PlacesMiscellaneous RetailChoose Subindustry(Required)Depository InstitutionsNon-depository Credit InstitutionsSecurity And Commodity Brokers, Dealers, Exchanges, And ServicesInsurance CarriersInsurance Agents, Brokers, And ServiceReal EstateHolding And Other Investment OfficesChoose Subindustry(Required)Hotels, Rooming Houses, Camps, And Other Lodging PlacesPersonal ServicesBusiness ServicesAutomotive Repair, Services, And ParkingMiscellaneous Repair ServicesMotion PicturesAmusement And Recreation ServicesHealth ServicesLegal ServicesEducational ServicesSocial ServicesMuseums, Art Galleries, And Botanical And Zoological GardensMembership OrganizationsEngineering, Accounting, Research, Management, And Related ServicesPrivate HouseholdsMiscellaneous ServicesSoftware and TechnologyChoose Subindustry(Required)Executive, Legislative, And General Government, Except FinanceJustice, Public Order, And SafetyPublic Finance, Taxation, And Monetary PolicyAdministration Of Human Resource ProgramsAdministration Of Environmental Quality And Housing ProgramsNational Security And International AffairsAdministration Of Economic ProgramsNon-classifiable EstablishmentsDate(Required) Day Month Year Note: Premiums are payable in advance. Sublimits and Excesses apply.Are you interested in a higher Funds Protect cover limit?(Required) Yes No Brokerage DetailsBrokerage Name(Required) Broker Name(Required) Broker Email(Required) Broker Phone Number(Required)Underwriting Questions1. Does Your Business have an active, comprehensive, paid for internet security software installed on all computer systems?(Required) Yes No 2.1. Do you back up your data on a weekly basis?(Required) Yes No 2.2. Do you perform recovery testing at least once per year?(Required) Yes No 3. Is your data stored separately from your main computer e.g. via the cloud or on an offline hard disk?(Required) Yes No 4. Do you regularly update and patch your computers so that they always have the latest security patches installed?(Required) Yes No 5. Are all the emails received and sent by your workplace computers and network checked for viruses/malware via an email filter?(Required) Yes No 6. Are your employees regularly advised about the secure use of their workplace computer, especially regarding the dangers of using the internet/email?(Required) Yes No For Funds Protects cover limits above R250 000, please complete the additional questions below:7.1. Do you have documented procedures in place for vetting of new vendors/customers/payees? Yes No 7.2. Do you have documented procedures in place to verify new beneficiaries loaded onto your business’s banking profiles for funds transfers? Yes No 7.2. Do you have documented procedures in place to verify requests to amend existing beneficiary payment details? Yes No 8. Do you utilise account verification services offered by your bank or third party provider? Yes No Bank Name:(Required) Account Name:(Required) Account Number:(Required) Branch Name:(Required) Branch Code:(Required) Account Type:(Required) Debit Date:(Required) Day Month Year I agree(Required) I AgreeI, the undersigned, hereby authorise the appointed collection agent to deduct the premiums on behalf of the Insurer starting on the inception date or the next business day. Deductions from my account will be treated as though they have been signed by me personally. I acknowledge that premiums are collected in advance and not arrears and that cancellation of this debit order will automatically cancel the policy. I understand that it is my responsibility to ensure that premiums are received by the Insurer. I acknowledge in the event of failed / rejected debits I may incur additional charges as levied by my bank for which I will be responsible for. I also understand that I cannot reclaim any amounts which have been withdrawn from my account in terms of this authority and mandate if such amounts are legally owed.Date Day Month Year Protection Of Personal Information We at Phishield UMA (PTY) Ltd, respect your constitutional right to privacy. We are committed to and bound by the terms and provisions of the Protection of Personal Information Act 4 of 2013 (“POPIA”) regarding the acquisition, usage, retention, transmission and deletion of your personal information. We will check and validate the information you provide through legal means. We have high level security measures in place to protect your personal information. Your personal information herein collected is for the primary purpose of providing you with insurance cover and for all other activities and processes incidental to and relevant to this purpose. Your information shall be kept confidential; however, we shall disclose it to certain third parties as required and other insurers for the specific purpose of insurance and to reduce and prevent any form of fraudulent activity. Sharing of information includes, but is not limited to, information sharing as arranged via the South African Insurance Association. You hereby give consent and fully understand the reason for Phishield UMA to process, use, share and retain your personal information for its designated purpose and you confirm the accuracy of the information. You may request Phishield to amend, update, change or correct your personal information processed by us by sending a request to our offices on the following email address email@example.com For a full version of the Consent to process Personal Information is available on this link www.phishield.com for download. Should you decide to cancel this insurance contract you further consent to Phishield UMA retaining the information in line with the legally permitted retention period, for statistical and reporting purposes only. Should you decide not to accept the proposal, the information collected, will be de-identified and only used for statistical and research purposes.Policy Holder Declaration:(Required) I agreeI, the undersigned have made an informed decision to take out this policy without the benefit of a full financial needs analysis. Further, I warrant that I have taken note and understand the cover limits and the limitations of this policy. I understand that this is an application for a binding insurance contract on the insurer and myself but may be subject to further acceptance of terms and conditions for this contract to become binding. I further declare that all the information entered by me on my behalf is true and correct and should any further information be required, I will make this available to the Insurer as necessary for my policy or any query related to the policy. I am in no way entering this agreement with the knowledge of undisclosed event or expected future event. I understand that any misrepresentation, concealment of facts and/or non-disclosure in respect of information provided herein shall render my claim and policy null and void.Date(Required) Day Month Year NameThis field is for validation purposes and should be left unchanged.