Cyber Insurance Incident Claim
Policy Information
Policy Number
Insured Name
Contact Person
Contact Email
Contact Phone
Incident Details
Date of Incident
Date Discovered
Type of Incident
Data Breach
Malware
Ransomware
Phishing
DDoS Attack
Other
Incident Description
Affected Systems / Data
Systems Affected
Data Affected
Actions Taken
Actions Taken to Mitigate
Authorities Informed (Yes/No)
Yes
No
Details (If Yes)
Claim Details
Estimated Loss Amount
Supporting Documents