Value Based Risk Matrix Intake Form

Financial Information

Last Complete
Financial Year

Current Year
(Estimate)

Next Year
(Estimate)

Gross Annual Revenue

26. During the last three years has anyone alleged that their personal information was compromised or has the applicant notified customers that their information was or may have been compromised?

27. During the last three years has the company suffered any unscheduled network outages lasting more than 6 hours?

28. Is the company or any of its partners, directors or officers aware of or are there any circumstances that may give rise or have given rise to a claim under existing insurance policies?

29. During the last three years has any person or organization brought a lawsuit or made a claim against you involving copyright infringement, trademark infringement, patent infringement, consumer litigation, a defamation action or a privacy violation?

30. During the last three years has anyone alleged or have any claims been made against the applicant in relation to disparagement, copyright infringement or trade mark or trade name infringement?

Insurance Policy Information