Tuesday, 07 February 2012
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Film and Video Liability

  1. Please click here to read important information on the Film and Video Insurance Questionnaire

  2. Client / Company name(*)
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  3. A.B.N. Number (if applicable)
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  4. Contact Person(*)
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  5. Postal address(*)
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  6. Suburb(*)
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  7. State(*)
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  8. Postcode(*)
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  9. Phone number(*)
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  10. Fax number
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  11. Email address(*)
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  12.  
  1. Business activities to be insured (please describe your activities in as much details as possible)(*)
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  2. How many years experience do you have in this field and/or how long has your business been operating for?
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  3. Period that Cover is require for(*)
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  4. From(*)
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  5. To:(*)
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  6. Limit of cover required:(*)
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  7. Location of risk (please provide address or location of where you will be predominantly carrying out your business activities):
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  8. Do you carry out any activities outside of Australia?
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  9. Please advise the estimated turnover / wages of your business for the next 12 month period? If cover only required for short term period or one-off event, please provide estimated turnover or budget for short term period/one-off event.

  10. Turnover $ (Gross Income)(*)
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  11. Wages $
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  12. (Please provide provide percentage of work conducted overseas & names of countries).
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  13. If cover only required for short term period or one-off event, please provide estimated turnover or budget for short term period/one-off event.

  14. Number of employees
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  15. If you are a non-profit organisation, total number of members
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  16. Do you use contractors / sub-contractors?
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  17. What activities will your contractors carry out?
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  18. Estimated payments to contractors / sub-contractors $
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  19. Do you insist on your contractors / sub-contractors carrying their own public liability insurance? (This will be a condition of cover)
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  20. Will you be signing any contracts that contain hold harmless or indemnity agreements?
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  21. If yes, please provide copies of such agreements.
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  22. Note – a hold harmless or indemnity agreement is whereby one party assumes the liability risks of another party under contract. Your public liability policy is to cover your legal liability & no one else’s, therefore claims arising from these agreements are excluded. In some circumstances, your policy can be amended to include cover for these agreements providing your Insurer can review them & agree to their content. If you sign these agreements without first referring them to your Insurer, you may not be covered in the event of a claim.

  23. Will you require cover for liability claims arising from loss or damage to other people’s property whilst in your care, custody or control?
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  24. If yes, please advise limit of cover? $
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  25. Note – the above extension only operates if you are negligent in causing the loss or damage to the property in your care, custody or control. There can be situations where you have hired or borrowed other people’s property, & such property is lost or damage not as a result of your negligence. However, you may still be responsible for compensating the owner for their loss. In these circumstances, it would be prudent not to rely on the above extension on it’s own but also insure the hired or borrowed property under a General property insurance policy, which will operate regardless of fault or negligence.

  26. Have you suffered any public liability claims or have caused incidents that could give rise to a public liability claim?
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  27. If yes, please provide details
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  28. Have you previously been insured for public/products liability?
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  29. If yes, please advise name of Insurer?
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  30. Will your activities include the use of any of the following:

  31. Registered motor vehicles
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  32. Watercraft
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  33. Aircraft or hovercraft
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  34.  
  1. Are you the overall producer of the Production(s)?
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  2. If no, please advise your responsibilities & duties:
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  3. What type of productions will you be filming?

  4. Feature films
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  5. Documentaries
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  6. TV productions
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  7. Corporate videos
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  8. Private & public events or occasions
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  9. TV Commercials
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  10. Music video clips
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  11. Other productions – please describe
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  12. If annual cover required, please advise estimated number of productions during next 12 month period?
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  13. Estimated number of filming days(*)
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  14. Estimated production budget:

  15. For annual period if required
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  16. For one off or short term period $
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  17. Will your productions involve the use of:

  18. Will there be large crowds involved in the production(s)?
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  19. Fire, fireworks, pyrotechnics
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  20. Stunts or explosions
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  21. Dangerous activities (if so, please describe below)
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  22. Describe Dangrous Activities
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  23. Aircraft, watercraft or motor vehicles
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  24. If you have answered YES to any of the above, please provide detail
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  25. Where will majority of the filming take place
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  26. If on location, please provide the percentage of work on location & details:
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  27. Please provide a Synopsis of your Film(s) – if applicable:
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  28. Where did you here about Action Entertainment Insurance?
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  29.  
  1. OTHER INSURANCES

  2. We recommend the following other insurances and ask that you contact our office if you would like further information on any of these including quotations:-

  3. VOLUNTARY WORKERS ACCIDENT INSURANCE
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  4. WORKERS COMPENSATION (COMPULSORY FOR ALL EMPLOYERS
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  5. MONEY
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  6. BUSINESS EQUIPMENT (INCLUDING HIRED OR BORROWED ITEMS)
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  7. PROFESSIONAL INDEMNITY FOR EVENT ORGANISERS
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  8. NEGATIVE FILM RISK
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  9. ERRORS & OMISSIONS FOR PRODUCTIONS
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  10. FILM EQUIPMENT
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  11. FILM PRODUCERS INDEMNITY
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  12. Additional Info
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  13. DECLARATION I/We hereby declare that the information provided by me/we in this questionnaire is true and correct and that I/we have read and understand the Important Notices at the start of this questionnaire. I/We also agree that this questionnaire can be used as the proposal of insurance and therefore the the basis of the contract of insurance between me/we and the underwriter, if so approved by the underwriter.In submitting this form, I acknowledge that I may receive documentation from Action Insurance Brokers P/L by email. I further agree that Action Insurance Brokers P/L may from time to time send me important information about new insurance products and services.
  14. I/We agree:(*)
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  15. Anti-Spam
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  16. Submit