Film & Entertainment Public Liability Insurance Fact Finder

1. Insured Name:*

2. ABN:*

3. Address:*

Street Address City State / Province / Region Post Code Country

4. Contact Name:*

5. Contact Email:*

6. Contact Phone:*

7. Number of employees:*

8. Additional Insured(s) (if applicable):

9. Interested parties (if applicable):

10. Business activities (must confirm all):*

11. How many years of experience in the business activities declared:*

12. Period of Insurance:

From*

To*

13. Gross Annual Production Costs:*

14. Gross Revenue:

15. Limit of Indemnity:*

i. $10,000,000 (AUD)
ii. $20,000,000 (AUD)
iii. $50,00,000 (AUD)

16. Do you require any drone liability insurance:*

Yes
No

17. Geographical Limits:*

Australia Wide
World Wide

18. List of any filming locations (if known):

19. Are there any stunts, scenes involving animals, motor cycles, special vehicles, watercraft, aircraft, explosives, pyrotechnics, use of trains/railroad or any other hazardous activities:*

Yes
No

Supplies full details here. If not known please confirm you will supply GALVANiiZE Insurance with the safety report and / or risk assessment with full details for the Insurers consideration.

20. You acknowledge the Film & Entertainment liability policy will have a strict stunts and hazardous exclusion. No cover is granted unless confirmed in writing by the Insurer upon receipt and acceptance of the safety report and/or risk assessment:*

Yes

21. You acknowledge the Film & Entertainment liability policy attracts the following exclusions and other insurance may be required via GALVANiiZE Insurance:

i. “ANY” Aviation/Aircraft/Hovercraft (this includes Planes and/or Helicopters).*

Yes

ii. “ANY” registered Vehicles (Buses, Trucks, Motorhomes, Cars, Bikes, Cherry Pickers, etc.).*

Yes

iii. “ANY” Boat or Marine Vessel greater than 10 metres.*

Yes

iv. Construction - Contract values in excess of $500,000 (AUD).*

Yes

22. Have any of the Insureds:

i. Ever been convicted of a criminal offence relating to arson, fraud or otherwise involving dishonesty?*

Yes
No

ii. Ever had any insurance declined, cancelled or made the subject of special terms or conditions?*

Yes
No

iii. Lodged a claim on an insurance policy (other than for a motor vehicle or a life policy) during the past 5 years?*

Yes
No

23. Have any of the Insureds arranged any other Film Liability insurance through another Insurer?*

Yes
No

24. Have any of the Insureds entered into any agreement which would affect your right to make a claim against a responsible Third Party in the event of a claim under the insurance now being proposed?*

Yes
No

25. Have you read the following GALVANiiZE Insurance compliance documents:

Important Notices

General Advice Warning

Major Uninsured Risks

View Required Compliance Here

DECLARATION

This Declaration must be signed by the intending insured. If the intending insured is a company, partnership or other business venture or involves more than one person or entity, then the person signing this declaration must be the one authorised to sign on behalf of all persons/entities identified as the intending insured. Before completing this document, I/We have read and understood the information herein, including the GALVANiiZE Insurance Important Notices, General Advice Warning and the Major Uninsured Risks. The answers given in this FACT FINDER / PROPOSAL FORM and any other information supplied by the intending insured or by any other party on their behalf, are truthful and accurate. I/We understand that the Insurer(s) are relying on information supplied herein to decide whether or not to accept or reject this risk and that no material information has been knowingly withheld.

Signature*

Date: 19/04/2024

Print Name:*

Position / Title:*

Name

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

Australian Film & Entertainment Public Liability Insurance Fact Finder

Australian Film & Entertainment Public Liability Insurance Fact Finder

Please fill out form and submit

DECLARATION

How can we help?

联系我们

电话
1300 088 008

Australian Film & Entertainment Public Liability Insurance Fact Finder

Australian Film & Entertainment Public Liability Insurance Fact Finder

Please fill out form and submit

DECLARATION

How can we help?

联系我们

电话 1300 088 008

电话
1300 088 008