VPN and Internal Pen Test Authorisation

The purpose of this form is to grant authorization to London Consulting Ltd. information security team and/or their information security contractors or partners to conduct internal vulnerability assessments and penetration tests against the below mentioned organisation or company IT assets. To that end, the undersigned attests to the following: 1) London Consulting Ltd. has permission to scan the organisation's internal computer or network equipment to find vulnerabilities. This permission is granted from the start date until the end date (mentioned below) both dates inclusive. 2) The undersigned, has the authority to grant this permission for testing the organization's Information Technology assets. 3) London Consulting Ltd. will take the necessary steps to conduct the internal vulnerability assessment and Pen Test according to best practices. And the below mentioned organisation or company submits that it has taken (or will take) all the necessary steps to ensure operational continuity during (knowing that during the test a slight network disruption is acceptable) and after this test. And hereby indemnifies and holds harmless London Consulting Ltd. for any interruption or losses of any kind in case they occur as a result of this test. 4) A VPN user account will be granted to facilitate the access to the below mentioned Company internal network. Separate VPN credentials will be created and entered on this form and used for the sole purpose of conducting the above mentioned tests. Those credentials should never be shared with any other user, contractor, or service provider. 5) The below mentioned Organisation or Company is fully responsible for managing its VPN environment including but not limited to the creation, assignment, revocation or deletion of VPN access accounts, the proper routing of Virtual Private Traffic, and the utilisation of the proper Encryption standards.

Organisation or Company name (required)

Contract Number (required)

Start Date YYYY-MM-DD (required)

End Date YYYY-MM-DD (required)

Please enter the Internal IP Ranges and Subnets that are to be tested one IP/Subnet on each line (required)

Please enter the VPN Access Credentials (user name, public server FQDN or IP, password or passphrase). If a signed certificate is required you can paste its content here (required)

Email (required)

Authorised by (required)