Media Liability Insurance Application Review Form

Media Liability Insurance Application Review Form
The scope of this consultation is to help INN members better understand, effectively communicate and complete applications for media liability insurance. We are not acting as or taking the place of an insurance broker or agent, who is an indispensable part of the insurance process and should be actively involved. Additionally, you may want to involve your attorney.
Are you an INN member?

Yes No
Contact person:
Phone
Email:
example@example.com
Name of Entitiy(ies) to be insured:
Websites for Entity(ies):
Broker (If you are currently insured):
Broker's phone number:
Broker's Email
example@example.com
Are you a new buyer of media liability insurance?

Yes No I don't know
If you have a current media liability policy...
What is the name of the insurer?
What is the expiration date?
Is existing coverage being renewed with the current insurer?
Will you be applying for media liability insurance from other insurers?
Please attach the following:
Your current insurance application

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Cancel of
Your most recent application, if available

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Cancel of
Your current media insurance policy, with all endorsements and declarations

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Cancel of
Once you complete and submit this form, Chad Milton and/or Michelle Worrall Tilton of Media Risk Consultants will promptly contact you by phone or email to confirm receipt and to set up a conference call to discuss you insurance application. We encourage you to include your broker and attorney on the conference call with us.
Disclaimer: The consulting provided by the principals of Media Risk Consultants LLC is not legal advice and should not be construed as such nor does it create an attorney-client relationship. Media Risk Consultants does not sell insurance or otherwise act as an insurance broker.
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