Annual Proposal Fact Find

Film & Media Insurance Quote form.

Step 1 of 5

20%

Contact

Producer / Contact Name(Required)

Production Company Name(Required)

Address(Required)

Street Address Address Line 2 City Post Code

Email(Required)

Phone(Required)

Website(Required)

Business

Type of Productions /Business Activity(Required)

Animation

Branded Content

Corporate Videos

Documentaries

Educational Film

Music Promo

Photo Shoots

Social Media Content

Short Films

TV / Web Commercials

TV / Web Series

Weddings

Other

Please provide some details(Required)

When was the company established? (date)(Required)

Insurance Period

When would you like the policy to start

MM slash DD slash YYYY

When would you like the policy to end (if short period)

MM slash DD slash YYYY

Territories / Locations Required(Required)

Material Damage

Do you require Cover for Technical Equipment?(Required)

Yes

Technical Equipment: Owned (Any Location) - Cover Required(Required)

Technical Equipment: Owned (Premises Only) - Cover Required(Required)

Technical Equipment: Hired from Suppliers - Cover Required(Required)

Technical Equipment: Loss of Hire / Continuing Hire Charges (13 weeks) - Cover Required(Required)

Do you require Cover for Props, Sets & Wardrobes?(Required)

Yes

Props, Sets & Wardrobe: Owned - Cover Required(Required)

Props, Sets & Wardrobe: Hired from Suppliers - Cover Required(Required)

Props, Sets & Wardrobe: Loss of Hire / Continuing Hire Charges (13 weeks) - Cover Required(Required)

Do you require Cover for Office Contents (not including cover for non-computing or non-technical elements)(Required)

Yes

Office Contents (Non-Computing / Non-Technical) - Cover Required(Required)

Do you have a self-contained unit?(Required)

Yes

Please provide the address and any pertinent details(Required)

Premises Security - Alarms(Required)

None

Audible / Bells only

Digital Communicator

Redcare / Dualcom

Premises Security - Physical

CCTV (internal)

CCTV (external)

Shutters (front)

Shutters (rear)

Window Locks

Side Bars

Gated Compound

24/7 Manned

Liability

Do you need Public Liability Cover?(Required)

Yes

Public Liability Cover Required(Required)

Estimated Number of Productions Annually(Required)

Estimated Annual Gross Production Costs / Turnover(Required)

Please enter a number greater than or equal to 0.01.

Will you undertake any Hazardous / Non-standard Activities(Required)

Fire / Pyrotechnics or Special Effects(Required)

Yes

Please provide some details(Required)

Do you need Employers Liability Cover?(Required)

Yes

Employers Liability Cover Required(Required)

Are you exempt from holding an Employers Reference Number?(Required)

Yes

Please select the reason you are exempt(Required)

Can you provide the Employers Reference Number now?(Required)

Yes

ERN (Employers Reference Number)(Required)

Estimated Wage Roll / Contractors(Required)

Maximum Number of Employees / Contractors at any one time(Required)

Do/Will you employ non-UK Domiciles?(Required)

Yes

Work at Heights above 3 metres(Required)

Yes

Please provide some details(Required)

Use of Woodworking Machinery or Heat(Required)

Yes

Please provide some details(Required)

Do you require Professional Indemnity Cover?(Required)

Yes

Professional Indemnity - Cover Required(Required)

Production

Do you require Media Footage Cover?(Required)

Yes

Media Footage - Cover Required(Required)

Do you require Extra Expense Cover?(Required)

Yes

Extra Expense - Cover Required(Required)

Do you require cover for Non-Appearance?(Required)

Yes

Non-Appearance - Cover Required(Required)

Any Other Requirements

Any Additional or Pertinent Information

Declations

Have you had any Claims or Losses within the last 5 years?(Required)

Yes

Please provide details on previous Claims / Losses (5 years)

Have you had any Insurance previously Cancelled or Declined?(Required)

Yes

Please provide details on any Insurance Previously Cancelled or Declined

Have you had any Convictions, Liquidations or Previous Bankruptcies?(Required)

Yes

Please provide details on any Convictions, Liquidations or Previous Bankruptcy

Are there any circumstances which you are aware of or ought reasonably to have been aware of, that might reasonably be expected to give rise to any claim or loss(Required)

Yes

Please provide details

Where did you hear about IMS?

Important Disclosure

All material facts must be disclosed. Failure to do so could invalidate the policy. A material fact is one which is likely to influence an insurer in the acceptance and assessment of this application. If you are in any doubt as to whether a fact is material then it should be disclosed to the insurer. I f any changes in circumstances arise during the period of insurance cover please provide your insurer with details.

Declaration(Required)

To the best of my knowledge and belief the information and statements provided in connection with this proposal, whether in my hand or not, are true and complete and no material facts or information have been withheld or suppressed. I understand that non-disclosure or misrepresentation of a material fact may entitle insurers to void the insurance. (N.B a material fact is one likely to influence acceptance or assessment of the risk by insurers. If you are in any doubt as to whether a fact is material or not, please disclose it.). I understand that signing this declaration does not bind me to complete, or insures to accept, this insurance. I understand and agree that insurers may seek information from credit and other agencies in connection with this proposal.

I agree

Date

DD slash MM slash YYYY

Phone

This field is for validation purposes and should be left unchanged.