1.) You have anti-virus software installed and enabled on all desktops, laptops, and servers (excluding database servers) and it is updated on a regular basis.

2.) You have firewalls installed on all external gateways.

3.) You take regular back-ups (at least weekly) of all critical data and store the same offsite or in a fire-proof safe, or your outsourced service provider meets this requirement

1.) You have conducted a review of the business to ensure compliance with all relevant HIPAA legislation.

2.) You ensure that all PHI transmitted over open networks and/or stored on portable devices is encrypted.

1.) You have been certified as being PCI compliant within the last 12 months, or have successfully completed a self-assessment audit.

1.) After full inquiry, you are not aware of any circumstances, complaints, claims, loss, penalties, or fined levied against you in the last five years, in relation to the risks that this application relates to.

2.) You are not aware of any circumstances or companies against you in relation to data protection or security, or any actual security violations or security breaches either currently or in the past five years.

I declare that after proper inquiry the statements and particulars given here are true and that I have not mis-stated or suppressed any material fact.

I agree that this application form, together with any other material information supplied by me shall form the basis of any contract of insurance effected thereon

I undertake to inform underwriters of any material alteration to these facts occurring before completion of the contract.