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SCDOI Online Reporting Form Section 12 Section 12. Attachments Items to Attach: 1. A report of the results of any internal review identifying a lapse in either automated controls or internal procedures, or confirming that all automated controls or internal procedures were followed. 2. A copy of the licensee's privacy policy. 3. A statement outlining the steps the licensee will take to investigate and notify consumers affected by the Cybersecurity Event. File Click to select file Click to select file Click to select file Click to Add File(s) Section 13. Attestation Document Type Internal Review Privacy Policy Investigation Outline Action I attest, to the best of my knowledge, that the information submitted on this form is true and correct to the best of my information and belief. By submitting this form, I am acknowledging that I am authorized to submit this form on behalf of the licensee or company. I further understand and agree that Section 38-99-60 of the South Carolina Code of Laws affords confidential treatment to certain information submitted to the SCDOI in accordance with Chapter 99. However, I understand that under state or federal law, the South Carolina Department of Insurance may be required to release statistical or aggregate information provided in this cybersecurity event notification. I acknowledge that copies of consumer notices may also be made available via the Department's website and the Department may also make available summary information related to cybersecurity events requiring public notification such as the identity of the licensee or third-party service provider, the number of individuals affected, the actions taken by the licensee to remedy the cybersecurity event and services available to consumers. I understand that Section 38-99-60 also gives the Director the authority to use the documents, materials or other information furnished by a licensee or someone acting on the licensee's behalf in furtherance of regulatory or legal actions brought as a part of the director's duties. Yes Submit Report

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