Annual Proposal Fact Find

Contact

Producer / Contact Name(Required)

Production Company Name(Required)

Address(Required)

Street Address Address Line 2 City Post Code

Email(Required)

Website(Required)

Business

Type of Productions /Business Activity(Required)

Please provide some details(Required)

Trading Date (Established Date)(Required)

Territories / Locations Required(Required)

Any Additional or Pertinent Information

Declations

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

Yes

No

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

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

Yes

No

Please provide details on any Insurance Previously Cancelled or Declined

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

Yes

No

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

No

Please provide details

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

Contact

Business

Material Damage

Liability

Production

Declations

Important Disclosure