Insurance · community shared

Cyber Insurance Intake Form — shared by the community

Yusuf E. shared this 14-question build with 3 conditional rules already wired up. Test it below, then take a copy.

A ready-to-use insurance form for small teams who need a reliable intake process: 14 questions, 3 pages, 3 conditional rules.

Shared by
Yusuf E. · Recruitment partner
Questions
14
Replies
9
Copies taken
478
See the library version

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Live preview and test console

This is the real form. Answer it to test the 3 conditional rules — nothing is sent or stored.

Page 1 of 3Business And Contact

Start Your Cyber Insurance Inquiry

Use the entity seeking coverage, not just its trading name.

Choose the activity responsible for the largest share of revenue.

Enter total revenue for the most recently completed financial year, rounded to the nearest thousand. Use zero if pre-revenue.

Every question on this page is currently visible.

Works for you? Take Yusuf E.'s copy into your own workspace — questions, rules and settings included.

Who this template is for

Cyber Insurance Intake Form is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.

  • Small teams who need a reliable intake process working in insurance.
  • Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
  • Anyone replacing chasing missing details over email with one structured record per enquiry.
  • Respondents are the people you send it to — the form asks them 14 questions across 3 screens.
  • Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.

  • 11 questions are required, so submissions arrive complete instead of needing a follow-up email.
  • It collects a verified email address so replies and confirmations land.
  • It pins the request to a specific date.
  • It captures a numeric value you can filter and sort on.
  • Conditional logic hides 3 questions until they are relevant — shorter forms convert better than long ones.
  • Splitting the form across 3 pages keeps each screen short and shows respondents how much is left.
  • Every response is stored, searchable and exportable, so nothing depends on one person's inbox.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

  1. 1Press “Use this template” — a fresh copy of Cyber Insurance Intake Form lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
  4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
  5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 3 conditional rules ship with it.

  • Features advanced show logic: if “Multifactor authentication coverage” is Not fully implemented, the form dynamically exposes “Multifactor authentication gaps”. Otherwise that question never appears.
  • Features advanced show logic: if “Cyber incidents in the past three years” is Yes, the form dynamically exposes “Incident summary”. Otherwise that question never appears.
  • Features advanced show logic: if “Current cyber insurance” is Yes, the form dynamically exposes “Current policy expiration date”. Otherwise that question never appears.
  • All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

What this form asks

Page 1 — Business And Contact

  • Legal business namerequired
  • Primary contact namerequired
  • Work emailrequired
  • Primary business activityrequired
  • Annual revenue in USDrequired

Page 2 — Data And Security Controls

  • Individuals with sensitive recordsrequired
  • Multifactor authentication coveragerequired
  • Multifactor authentication gaps
  • Separated backups and restore testingrequired

Page 3 — Incident History And Timing

  • Cyber incidents in the past three yearsrequired
  • Incident summary
  • Current cyber insurancerequired
  • Current policy expiration date
  • Requested coverage start daterequired

Conditional logic in this build

  • WhenMultifactor authentication coverageis Not fully implemented, showMultifactor authentication gaps”.
  • WhenCyber incidents in the past three yearsis Yes, showIncident summary”.
  • WhenCurrent cyber insuranceis Yes, showCurrent policy expiration date”.

Questions about this shared form

Is this a complete cyber insurance application?

No. It is a first-pass intake for routing and preparation. A carrier may require additional questions, evidence, and its own application before making an underwriting decision.

What if we do not know whether a control is implemented?

Select “Not sure” and ask your IT lead or service provider to verify it. Do not answer yes based only on a rollout plan or a tool subscription.

Can we use this to report an active cyber incident?

No. This form is not an emergency response or claims-reporting channel. Follow your organization's incident process and any reporting instructions in your existing policy.

Which form should we use for other business coverage?

Use Business Insurance Quote for a broader business coverage inquiry. Use this intake when cyber exposure and security controls need their own focused review.

Is the Cyber Insurance Intake Form template free to use?

Yes. You can preview and test Cyber Insurance Intake Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Cyber Insurance Intake Form template ask for?

It asks 14 questions across 3 pages, 11 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Cyber Insurance Intake Form form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this insurance form work?

3 conditional rules ship with the template: Features advanced show logic: if “Multifactor authentication coverage” is Not fully implemented, the form dynamically exposes “Multifactor authentication gaps”. Otherwise that question never appears. Features advanced show logic: if “Cyber incidents in the past three years” is Yes, the form dynamically exposes “Incident summary”. Otherwise that question never appears. Features advanced show logic: if “Current cyber insurance” is Yes, the form dynamically exposes “Current policy expiration date”. Otherwise that question never appears. All rules are editable in the Logic tab.

Where do responses to the Cyber Insurance Intake Form form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Cyber Insurance Intake Form form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.