Get a Cyber Quote

Highland Risk Cyber Program

Input your information and get a quote in less than 24 business hours

Welcome to Highland Risk Services online Cyber quoting portal.

Complete the form below to receive a Cyber quote in less than 24 business hours. Should your risk fall outside of our program parameters, we welcome you to submit any completed cyber application to cybersubmissions@highlandrisk.com . Highland’s Cyber Application can be downloaded here.

For additional assistance please contact

Anjali Johnson

Vice President, Cyber

847-999-9489

Anjali.Johnson@highlandrisk.com

Please Note:

Completion of this application in no way will be considered a binder of coverage and underwriters do not guarantee that a policy will actually be issued upon receipt of a completed application. Whoever fills out this application must be a principal/ partner/ director/ officer or senior manager authorized to do so and should make all the proper inquiries to enable the questions to be answered. The application should be completed for the applicant and all subsidiaries*. A signed, completed and dated application will be needed upon binding along with any other outstanding subjectivities noted by the Highland Risk.

Highland Risk Cyber Program

  • Highland Risk Cyber Program
  • Basic Company Details
  • Coverage Required
  • Previous Cyber Incidents

Highland Risk Cyber Program

Are You a Licensed Insurance Agent?

Agency Name

First Name

Last Name

E-mail

Phone

Has your agency done business with Highland previously?

Basic Company Details

Company Name **

Primary Industry Sector **

Primary address (street, address line 2, city, sate, zip, country) **

Address Line 1

Address Line 2

City

State

Zip

Country

Description of Business Activities**

Website Address

Date Established

Last Complete Financial Year Revenue** (Must be greater than 0)

Last Complete Financial Year Revenue**

Approximate record count

If you have any supplementary information or applications, please upload it here. (word/pdf/image)

If you have any supplementary information or applications, please upload it here. (word/pdf/image)

Add More Files

Add More

Coverage Required

Cyber Incident Response

Other Cyber Incident Response

Cyber and Privacy Liability

Other Cyber And Privacy Liability

System Damage and Business Interruption

Other System Damage And Business Interruption

Cyber Crime

Other Cyber Crime

Previous Cyber Incidents

Previous Cyber Incidents

If yes, please provide more information below including details of the financial impact and measures taken to prevent the incident from occurring again

Cyber Incidents Message