Bajaj Allianz General Insurance Company Ltd.

Proposal Form: Entertainment Package Policy

Name of the
Applicant / Company
The Applicant is:
(One of the Following) Individual / Partnership Firm / Company / Corporation / Joint
Venture /

Others ________________________________

(Cancel whatever Not Applicable)

Postal
Business Address

City
&
PIN Code
Title of the Production
Language of
Production

Period Of Production
Start Date: ______________ End Date:
___________________

Total Number of Days:_____________

Number of Production Days: _____________ (Actual Shooting

Days)

Is the Production One

of the Following: Feature Film / Pilot / Special / Series / Mini Series /
Others__________

Number of Episodes ( If Series ): ________________ each

week.

Number of Weeks: _____________

Running Time : 15min / 30 min / 60 min / 90 min / 120 min / 180 and more

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 min____________.
Is the name of the
Production in likeness YES / NO
to any living person /
political event which If YES has any such permission been taken?
needs permissions?

(Attach separate sheet if required)

Is the there any Loan YES / NO / Self

taken from any Bank /
NBFI / Self If Yes Name
____________________________________________

Address:
_______________________________________________

Tel Nos.:____________________________________

Has the Applicant been YES / NO

Black listed by any of
the Associations. If YES – When

Has it been
resolved_______________________________________

Is the Applicant YES / NO

member of any
Association. If YES

Name:
_____________________________________________
Place:
Is there any court case YES / NO
pending against you? If YES give brief details

(Attach separate sheet if required)

Shooting Schedule (Attach separate sheet if required)

Time to be spent at each location / country etc.

Number of Scene’s

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Details of Safety
Feature involved (Attach separate sheet if required)
during the entire
shooting period
Give Details of the use Water Craft / Underwater Filming / Near Water / Use of Air
of the following Crafts / Trains & Railroads / Animals / Pyrotechnics /
Expensive Antiques, Jewellery / Auto /Auto / Motorcycle Chase
/ Crash / Filming above 50 feet / Underground Filming /
Give
Give Detailed
Production schedule a) Pre Production: (Attach separate sheet if required)

b) Principal Photography: (Attach separate sheet if

required)

c) Completion of Production Print: (Attach separate sheet if

required)

d) Scheduled Release /Air: (Attach separate sheet if

required)

e) Time interval between two schedules.

List of any Additional (Attach separate sheet if required)

Expenses you wish to
include in the
Insurable Production
Cost:
Details of Previous
Insurance Name of the company

Any Claims Made? _____________

If YES under what heading:

______________________________

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Cover about the Sum Insured Deductible
following

Cast _________ ________

Negative Film & Faulty Stock _________ ________

Props, Set & Wardrobe _________ _________

Miscellaneous Equipment _________ _________

Extra Expenses _________ _________

Third Party Property Damage _________ _________

Give Details for cast
insurance Person to be insured ________________________________

Start dates ________

Age ________

Coverage desired ____________________________

Stop dates _________

Coverage period __________

Capital Sum Insured ______________________

Period of Principal Photography from _________to ______

Are any of the covered Yes / No

persons functioning in
a dual capacity?

Is any covered person Yes / No

involved in another
production before the If YES, please explain.
start of principal
photography?

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Is any covered person Yes / No
planning any vacation (If so where and how long?)
before the start of
principal
photography?

Is any covered person Yes / No

planning any medical If YES, please explain.
procedures before the
start of principal (medical certificate as per proforma to be attached)
photography?

Give details for

Film stock insurance Type of film /video used _______________________

Any special computer- Yes / No

generated graphics,
animations or other If so, please explain.
process involved?
Any special film Yes / No
processes, special
effects or equipment?
Any telecine Yes /No
processes involved?

Name and address if

the studio /laboratory
to be used
Vaults to be used
Cutting rooms to be
used
Name and address of
processing/ post
laboratory
Negative / videotape to By (mode of transport) ____________________________
be transported to
processing lab / post Frequency _____________________
production facility
When will rush prints
and /or recorded
videotapes be checked
and /or viewed?

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Will you be using any Yes / No
specialized computer
programs to create any If YES, please explain and name the software
images or effects?
Will you be using any Yes / No
special film or If so, please explain.
cameras?
Where will the film be
stored?
Give details of Camera/ lenses/ raw stock/ equipment
procedures the
applicant follows in (certificate to be attached)
testing
(to prove them to be
sound prior to
commencement of
filming or taping)
Details of props, set List of equipments which will be used for outdoor/indoor
and wardrobe shooting. (Attach separate sheet if required)
Equipment owned or
hired and value?
Duration of hire?
Method of
transportation?
How are you going to
protect the property
(theft/fire etc.)
Identify any equipment
props, set or wardrobe
with a value in excess
of Rs 50.000
Identify any antiques,
art work or precious
objects valued in
excess of Rs 10,000
subject to valuation
certificate
Maximum time needed
to rebuild destroyed
sets
Identify any
unique/one off pieces
of property or unusual
locations to be used

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Do you have access to Yes/No
any alternatives? If YES, please explain
Details of List of equipment which will be used for outdoor /indoor
miscellaneous shooting
equipment (Attach separate sheet if required)
Equipment owned or
hired and value?
Duration of hire?
List of item(s) over RS.
50.000
Brief description of
protection of property
Where will the
equipment be kept
during use?
Location to which the
equipment will be
returned when not in
use?
Details of third party Are there scenes involving residential locations?
property damage Yes /No
Are equipments / Yes/No
machineries in sound
conditions of repair?
Details of surrounding
areas/property/
population?
Scenes which may (property following fire etc.?)
cause damage to Yes /No
surrounding?
Signing this proposal does not bind the Applicant or the Company to complete
the insurance, but it is understood and agreed that the information contained
herein shall be the basis of the contract should a policy be issued. If any of the
above questions have been answered fraudulently, or in such a way as to
conceal or misrepresent any material fact or circumstance concerning this
insurance of the subject thereof, the entire policy shall be void.
Any material change in Underwriter’s exposure must be reported immediately.

I / We herby declare that particulars contained herein are true and correct and
that no material fact has been withheld, omitted, suppressed, misstated or
misrepresented and also that this declaration/ proposal-cum-schedule forming
part of the Company’s standard policy shall be the basis of the contract between
me /us and the Company, and be incorporated therein.

Place / Date: Signature of Proposer

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PROHIBITION OF REBATES

The following is the copy of Section 41 of the Insurance Act, 1938:

1. No person shall allow or offer to allow either directly or indirectly as an

inducement to any person to take out or renew or continue as Insurance in
respect of any kind of risk relating to lives or property in India any rebate
of part or whole or the commission payable or any rebate or the premium
show in the policy nor shall any person taking out or renewing a policy
accept any rebate except such rebate as many be allowed in accordance
with the published prospectuses or table of the insurer.

2. Any person making default in complying with the provisions of this section
shall be punished with a fine which may extend up to Rs 500 (Rupees
Five Hundred only)

Proposal Introduced by Name and Signature

of the Agent / Inspector

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