As a condition of the Insurer's agreement to authorize the binding of insurance, the undersigned declares that:

A. within the last five (5) years, no person proposed for this coverage has received any claim, suit or complaint, or experienced any loss resulting from a privacy breach, security breach, identity theft, denial of service attack, cyber extortion threat, computer virus infection (including malware or ransomware), phishing attack, cyber bullying or damage to third party networks;

B. no person proposed for this coverage has knowledge of any privacy breach, security breach, identity theft, denial of service attack, cyber extortion threat, computer virus infection (including malware or ransomware), phishing attack, cyber bullying or damage to third party networks which may give rise to a claim or loss; and

C. within the last five (5) years, no person proposed for this coverage has experienced a financial loss resulting from wire transfer fraud, credit card fraud, forgery, theft of money from a bank account by electronic means, or theft of cryptocurrency as a result of a security breach or computer virus infection.

The insurance for which you are applying will not respond to incidents about which any person proposed for coverage had knowledge prior to the effective date of the policy, nor will coverage apply to any claim or circumstance identified, or that should have been identified, in Section 2.a. through Section 2.c of this application.

NOTICE TO NEW YORK APPLICANTS: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE CONTAINING ANY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME.

The Applicant hereby acknowledges that he/she/it is aware that the limit of liability shall be reduced, and may be completely exhausted, by defense costs and, in such event, the Insurer shall not be liable for defense costs or any other amounts, including judgments and settlements, that exceed the limit of liability.

CALIFORNIA FRAUD WARNING

For your protection, California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

I HEREBY DECLARE that, after inquiry, the above statements and particulars are true and I have not suppressed or misstated any material fact, and that I agree that this Application shall be the basis of the contract with the Insurer.

The Applicant has read the foregoing and understands that completion of this Application does not bind the Underwriter or the Broker to provide coverage. It is agreed, however, that this application is complete and correct to the best of the Applicant's knowledge and belief, and that all particulars which may have a bearing upon acceptability as a NetGuard SELECT Insurance risk have been revealed.

It is understood that this Application shall form the basis of the contract should the Underwriter approve coverage, and should the Applicant be satisfied with the Underwriter's quotation.

It is further agreed that, if in the time between submission of this Application and the requested date for coverage to be effective, the Applicant becomes aware of any information which would change the answers furnished in response to any question of this Application, such information shall be revealed immediately in writing to the Underwriter.

This Application shall be deemed attached to and form a part of the Policy should coverage be bound.