• Media Professional Liability Insurance

    APPLICATION FORM

  • Please provide all information which may be material to the coverage you wish to purchase and which may influence the decision to insure you, what coverage is offered or the premium charged.

     

  • 1 | Your Information

    PLEASE ANSWER ALL QUESTIONS.
  • Format: (000) 000-0000.
  • National Press Club membership category/ occupation:*

  • 2 | Statements of Fact

    PLEASE VERIFY ALL STATEMENTS.
  • I obtain the appropriate licenses for any third party content used at all times.
  • 0/1000
  • I obtain written permission for the use of any individual third party references at all times.
  • 0/1000
  • I am not and will not be involved any investigative, exposé, adult content or true crime work.*

  • Coverage may be available with additional premium. More information about your work is required. Select "Next" to complete the Supplemental Application.

  • 2.1 | Supplemental Information

    REQUIRED FOR CERTAIN KINDS OF WORK.

  • Underwriters may agree, on a case-by-case basis, at their sole discretion, to extend your coverage to include some or all of the risk emanating from any of the listed activities. The information you provide here helps inform the underwriting review and determines what coverage, if any, you, personally, may be offered.

  • In which of the following areas do you currently, previously, or intend to work?
  • Does your investigative or exposé journalism involve the use of hidden cameras or concealed microphones?
  • Do you have procedures in place for takedowns and/or retractions?
  • Does your journalism publish the names or personal information of minors without parental consent?
  • Does your true crime journalism identify individuals or publish personal details before formal arrests are made?

  • 2.2 | Supplemental Information

    PUBLISHING

  • Please describe:

    1. legal review or editorial processes you use prior to publication or dissemination of any investigative or exposé-style reporting; and
    2. your processes for:
      1. ensuring the accuracy, originality and source(s) of disseminated content;
      2. handling unsolicited submissions;
      3. clearing content titles prior to dissemination.

  • 3 | Media Profesional Liability Insurance

  • The following table illustrates the policy limit options available to you based on your revenue from your last financial year.

     

    Media Profesional Liability Insurance Options
    (Revenue: up to $250,000)

    Policy Limit Premium Broker Fees Total*
    $250,000 $400 $75 $475
    $500,000 $500 $75 $575
    $1,000,000 $850 $85 $935
    $2,000,000 $1,250 $125 $1,375

      *Please note: State taxes not included.

  • The following table illustrates the policy limit options available to you based on your revenue from your last financial year. 

     

    Media Profesional Liability Insurance Options
    (Revenue: from $250,000 to $1,000,000)

    Policy Limit Premium Broker Fees Total*
    $250,000 $500 $75 $575
    $500,000 $850 $85 $935
    $1,000,000 $1,000 $100 $1,100
    $2,000,000 $1,500 $150 $1,650

      *Please note: State taxes not included.

  • 4 | Claims Experience

    PLEASE ANSWER ALL QUESTIONS.
  • Are you aware of any circumstance which may result in a claim under any of the insurance for which you are applying to purchase in this application form?*
  • Are you aware of any circumstance which resulted in legal action being made against you within the last 5 years.?*
  • Are you aware of any circumstance which resulted in cease and desist orders being made against you within the last 3 years.?*
  • Are you aware of any circumstance which resulted in a partner or director being found guilty of any criminal, dishonest or fraudulent activity or been investigated by any regulatory body?
  • Are you aware of any circumstance which resulted in a loss of data and privacy breach?

  • 5 | Authorization & Signature

    PLEASE REVIEW & SIGN.

  • Important notice

    By signing this form you agree that the information provided is both accurate and complete. CFC Underwriting will use this information solely for the purposes of providing insurance services and may share your data with third parties in order to do this. We may also use anonymized elements of your data for the analysis of industry trends and to provide benchmarking data.

    For full details on our privacy policy please visit www.cfc.com

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