Cyber Security and Risk Insurance Application

Fill Out the Cyber Insurance Form Online, or Download the printable PDF below:

For a straightforward way of obtaining a quote for your Cyber insurance needs, simply fill out the single page form below and email it to

Cyber Insurance PDF

    CYBER APPLICATION (Please complete ALL questions)

    Technical Assessment:


    Aggregate Limit Required


    Cyber Bullying Expenses

    reasonable expenses that insured or family member incur the cost of up to 20 hours of psychiatric services, professional digital forensic analysis, professional cyber security consultant service, professional public relations consultant

    Cyber Bullying Events

    means a series of three or more similar or related acts by the same person or group of persons that are
    intended to intimidate, harass, humiliate or defame that are committed against insured or family member

    Please do not hesitate to reach out if you have any questions at all.

    The right products, great service, the best people

    Contact Us

    Phone: 1–800–663–4200 or (250) 860-6700
    Fax: (250) 861–6060

    Monday to Friday: 8:30am – 5:00pm
    Closed Weekends and all Statutory Holidays.

    156-1876 Cooper Road
    Kelowna BC
    V1Y 9N6