PLEASE DO NOT USE THIS FORM FOR NEW ACCOUNT SUBMISSION, PLEASE REFER TO THE
SHORT TERM PRODUCTION OR ANNUAL PRODUCTION APPLICATION. THIS FORM IS TO DECLARE
A PRODUCTION ONLY ON AN EXISTING POLICY AND MAY REQUIRE APPROVAL FROM THE
INSURANCE COMPANY UNDERWRITER. |
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Welcome to
Declared Production EZ-Report from Entertainment Pro
Insurance.
For fast service on your
commercial accounts complete the form below and hit the “Step Two†button. Your
submission will be electronically delivered to the next available Commercial
Lines Underwriter.
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CONTACT INFORMATION
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Name of Company / Organization:
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Entity Type ( Indiv, Corp. LLC, etc.):
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Primary Address (No PO Box):
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Mailing Address (If different to primary):
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Contact Person:
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Phone:
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Fax:
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E-mail Address:
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QUALIFICATIONS QUESTIONS
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Any: Stunts, Pyrotechnics, Aircrafts, Boats, Animals, Race Tracks, Race Courses,
Helicopters, Motorbikes, Snowmobiles, Blanks, Squibs, Guns, Rap Music?
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If yes, check each exposure:
Stunts
Pyrotechnics
Aircrafts
Boats
Animals
Race Tracks
Race Courses
Helicopters
Motorbikes
Snowmobiles
Blanks
Squibs
Guns
Rap Music
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Is coverage required outside of the U.S. and Canada?
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Any Prior Production With Any Losses of Any Kind?
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PRODUCTION DETAILS
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FOR MUSIC VIDEOS ONLY
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(You will get a summary page
to review before submitting)
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