Name of Insured
Registration number
VAT number
Website / URL
Email Address
Contact number
Physical address
Postal code
Nature of operations
Choose an item
Advertising
Agriculture
Call center/telemarketing (please complete full proposal form)
Construction
Consulting
Data aggregator/processor (please complete full proposal form)
Education - Non-tertiary
Education - Tertiary (please complete full proposal form)
Energy provision and mining
Entertainment - Artists
Entertainment - Venue
Financial services - Accounting
Financial services - Asset management (please complete full proposal form)
Financial services - General insurance (non-life) (please complete full proposal form)
Financial services - Banking (please complete full proposal form)
Financial services - Insurance broking
Financial services - Investment and credit proider (please complete full proposal form)
Financial services - Investment/tax advisor
Financial services - Life insurance (please complete full proposal form)
Financial services - Other (Assets < R100 billion) (please complete full proposal form)
Financial services - Other (Assets > R100 billion) (please complete full proposal form)
Financial services - Payment gateway (please complete full proposal form)
Financial services - Payroll processing (please complete full proposal form)
Financial services - Stock exchange (please complete full proposal form)
Financial services - Venture capital investment
Gaming/gambling (including online gaming) (please complete full proposal form)
Hospitality - Accomodation
Hospitality - Restaurant
Human resources provider (please complete full proposal form)
Labour union (please complete full proposal form)
Internet service/hosting/cloud storage provider (please complete full proposal form)
Legal advice and services provider
Manufacturing
Media and publishing
Medical/healthcare (Revenue over R25m, please complete full proposal form)
Municipality/parastatal/government agency (please complete full proposal form)
Non-profit organisation
Other
Pharmaceutical and biotechnology provider
Real estate
Retail merchant
Technology development (hardware/software)
Technology service provider (Revenue over R25m, please complete full proposal form)
Telecommunications (please complete full proposal form)
Transport
Annual revenue
R0 - R10m
R10m - R25m
R25m - R50m
R50m - R100m
R100m - R150m
R150m - R200m
R200m - R250m
Number of employees
1. Are you domiciled in South Africa with no operations outside South Africa to be covered under this policy?
Yes
No
2. Do you collect, store or process less than all of the below:
100 000 personally identifiable records (name, ID number, contact details, address)
100 000 bank records or financial account details
100 000 unique payment cards per year (credit card, debit card)
50 000 medical records or health information
Yes
No
3. Please confirm if you have implemented the following security controls:
Active, paid for Internet Security software on all Sensitive Systems e.g Anti-Virus / Anti-Malware
Apply patches and updates noted as being critical by the provider within 1 month of release and general security related patches and updates within 3 months of release
Password controls including:
Minimum 8 characters
Passwords which are not easy to guess e.g. not consisting of your name, the company name or well-known simple passwords such as Password!1
Passwords changed at least quarterly unless multi factor authentication is implemented or 14-character passwords are used
Accounts are locked out after at most 10 failed authentication attempts
Resiliency controls including:
Weekly backup generation or replication (process of copying or reproducing data to a separate location)
Having a backup copy which is separate to or protected from your production (live/working) environment so that the likelihood of one incident impacting live and backup data is mitigated e.g. backup to cloud, disconnected/offline storage or ransomware protection enabled backup generation software
Test the ability to restore or read from backups at least every 6 months
Yes
No
Multi factor authentication to gain access to payment applications
Yes
No
If you have a company network, please confirm that you have implemented all the following:
Firewalls to restrict access to Sensitive Information
Where enabled, remote access is exclusively via secured channels such as virtual private network (VPN)
Sensitive System activity logs such as firewall and Active Directory (as used in your environment) are stored for at least 3 months
Yes
No
Not Applicable