First-Party Loss and Business Interruption a) Have any of experienced or had system or website used in any of the following types of you your security incidents or attacks (check all that apply)? security breach denial of service attack transmission of malicious code (ex: virus) identity theft disclosure of private information credit/debit card fraud repudiation of access network outage other security incident extortion threat/demand For each item checked above, please describe the incident or attack, impact to you, customers or others and what measures you have taken to prevent a similar event (attach additional sheets, if necessary) For each security incident or attack indicated above, please provide the following (attach additional sheets, if necessary): Type of Security Type of Security Incident or Attack: Incident or Attack: Duration of each outage Total net income loss due to the outage $ $ Total number of records affected in each security incident or attack Total cost for forensic examination to determine origin, extent and duration of $ $ each security incident or attack Total cost for notification to persons $ $ affected by the security incident or attack for call center costs associated with $ $ notice and for credit monitoring offered to $ $ affected persons Total legal costs associated with the $ $ security incident or attack $ PCI Fines $ PCI Fines Total amount of PCI fines and $ Government $ Government government fines Fines Fines Total costs for customer redress (other $ $ than referenced above)
First-Party Loss and Business Interruption a) Have any of you experienced or had your system or website used in any of the following types of security incidents or attacks (check all that apply)? security breach denial of service attack transmission of malicious code (ex: virus) identity theft disclosure of private information credit/debit card fraud repudiation of access network outage other security incident extortion threat/demand For each item checked above, please describe the incident or attack, impact to you, customers or others and what measures you have taken to prevent a similar event (attach additional sheets, if necessary) For each security incident or attack indicated above, please provide the following (attach additional sheets, if necessary): Type of Security Incident or Attack: Type of Security Incident or Attack: Duration of each outage Total net income loss due to the outage $ $ Total number of records affected in each security incident or attack Total cost for forensic examination to determine origin, extent and duration of each security incident or attack $ $ Total cost for notification to persons affected by the security incident or attack $ $ for call center costs associated with notice $ $ and for credit monitoring offered to affected persons $ $ Total legal costs associated with the security incident or attack $ $ Total amount of PCI fines and government fines $ PCI Fines $ Government Fines $ PCI Fines $ Government Fines Total costs for customer redress (other than referenced above) $ $
HIG_Professional_Liability_InsureWare2.0_Application.docx