On-line Book Publishers Defamation Insurance


Thank you for considering our on-line defamation insurance service.   Because Greater National Group is an insurance broker, not an insurance company, we will process your application with major insurance companies in order to find the right defamation insurance for you.

Please fill in the following form as fully as possible, then click 'submit' at the end of the form.
You can use the TAB key to move to the next field. We will respond with your terms as soon as we have researched the market for the right available deals that fit your requirements.


1a. Please state the limit of indemnity required: $
1b. What excess do you wish to pay towards a claim?: $
2. Occupation for which this insurance is required. Please check the appropriate box or boxes
Newspapers, Magazines and/or Trade Journals:
Proprietor
Publisher
Editor
Printer
Book Publisher
Television
Radio Broadcaster
Other
3. Date established:
4. How long operated by the present owners:
5. Are you at present insured for Defamation of Infringement of Copyright?
Yes No If Yes please email a copy of your current policy
6. Have you given any undertaking to indemnify any other party against claims for Defamation or Infringement of Copyright appearing in the publications or broadcast by the Radio or TV stations proposed for insurance?
Yes No
If Yes, please state the exact terms of such undertaking and to whom they are given:
7a. Do you Publish, Print or Broadcast (either on relay or otherwise) news/current affairs or other similar material prepared by others?
Yes No
If Yes, please provide details:
7b. If so, do you obtain an indemnity against claims for Defamation or Infringement of Copyright from the organisation or individual providing the source material, for your broadcast/publications?
Yes No
If Yes, please state exact terms of such undertakings and from whom they are obtained an in respect of which material:
8. Have any claims been made against you for Defamation, Infringement of Copyright, Trademark Design or Patent?
Yes No
If Yes, please provide details:
9. After enquiry, are there any circumstances which may result in a claim being made against you for Defamation, Infringement of Copyright, Trademark Design or Patent?
Yes No
If Yes, please provide details:
10. Do you wish to extend the indemnity provided to include indemnity for:
a. Unintentional Infringement of Copyright, Trademark Design or Patent?
Yes No
b. One automatic reinstatement?
Yes No
c. Undertakings referred to in Question 18 of the proposal?
Yes No
d. Retroactive Liability?
Yes No
11a. Total amount of turnover in the last 12 months? $
11b. Estimated amount of turnover in the next 12 months? $
11c. Please provide a percentage breakdown of the fee income disclosed in Question 11(a) by State or Territory.
NSW  VIC  QLD  SA  WA  TAS  NT  ACT  Overseas
%  %  %  %  %  %  %  %  %
12a. Please state the amount of indemnity required: $
12b. Please state the amount of excess required: $
13. Please provide details of ALL your anticipated releases for the next twelve months.
*Category: F=Fiction, A=Autobiography, B=Biography, E=Education, G=General, Non-Fiction
(Any publication not being proposed for insurance should be clearly noted)
If insufficient space, please attach a document with the relevant information
Title Author *Category
14. Please provide details of the number of releases made in the last twelve months. Divide into the following categories
a. Fiction
b. Autobiographies
c. Biographies
d. Educational
e. General, Non-Fiction


Duty of Disclosure:
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?
Yes No
If so, please provide details:
I/We hereby declare that:
My/Our attention has been drawn to the Important Notices accompanying this form and further I/we have read these notices carefully and acknowledge my/our understanding of their content. The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter between the date of this form and the inception date of the insurance to which this relates I/we shall give immediate notice thereof. I/We authorise GNG and the Insurer to collect or disclose any personal information about another individual (for example, an employee, or client), I/we declare that the individual has been or will be made aware of that fact and the Privacy Policy. I/We also confirm that I/we am/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this form and I/we complete this form on their behalf.
Any other comments, requests or relevant information you need to add:
Contacting you about your quote:
In order to select the most appropriate cover for you, it may be important to discuss quote details in person. Please leave a contact phone number and best time to call to facilitate this.
Your full name:
Company/Business/Name of Applicant to be Insured: Date of Commencement
Are you registered for GST purposes?
Yes No
ABN:
Your phone number (please include area code):
Your mobile phone number:
Best time(s) to call:
Please send my quote by (select at least one):
email phone fax mail
Your email address:
Your website address:
Your fax number:
Your postal address:
Country: