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Commercial – Intellectual Property (IP)

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Commercial - Intellectual Property (IP)

CLIENT INFORMATION
Applicant's Name*
First Last
*Applicant Name (s) will be the policy holder. If you need additional insureds there will be a place to list them later.
Address*
Street Address Address Line 2 City State ZIP Code
Phone number*
Website
Contact Name*
First Last
Contact Address (if different from above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Phone*
Contact Email*
Contact Fax
UNDERWRITING INFORMATION
Company Type
Date of Incorporation (formation)
MM slash DD slash YYYY
Continuously operating since:
Please describe the nature of your business.
Should coverage be offered, please indicate the Future Requested Effective Date.
Please list all additional insureds for which coverage is sought and their relationship to the MPMW.
Are you now planning, or in the last five (5) years have you or anyone representing you, your Company or any related company been involved in, any merger, acquisition, joint venture or purchase of business assets, including communications, discussions or negotiations which did not lead to a transaction?
- Yes
- No
If "Yes", please provide details.
Requested Policy Limit - Per Claim.
*Please indicate your interest.
Requested Policy Limit - Aggregate
*Aggregate Limits available are the same as per Claim Limits or higher. Please indicate your interest
Have you had IP Defense insurance before?
- Yes
- No
If “Yes”, please provide the name of carrier, limits, premium, and expiration date of the policy.
Indicate if you or your Company have been involved in any of the following:
International Trade commission actions?
- Yes
- No
Declaratory judgment actions?
- Yes
- No
PATENTS, TRADEMARK or COPYRIGHT related CIVIL PROCEEDINGS or settlement?
- Yes
- No
Other post-grant procedures (oppositions, reissue, re-exams, etc.)?
- Yes
- No
Other litigation of any kind filed by or against you in the past 3 years, including state actions?
- Yes
- No
If your answer to any of the above is “yes,” briefly give details and outcome.
MPMW
What SIC codes apply to the MPMW?
Are you currently in business selling the MPMW?
- Yes
- No
What ownership/contractual rights or relationship do you have to the MPMW?
- Owner
- Licensee
- Assignee
- Distributor
- Retailer
- User
- Other
*Please check all that apply
If "Other", please explain
Are you required by contract to carry IP Defense insurance?
- Yes
- No
If “Yes”, please provide details of type of contract, with whom, and limits required.
Is the MPMW to be insured manufactured by you?
- Yes
- No
Is the MPMW to be insured manufactured for you?
- Yes
- No
Is the MPMW to be insured manufactured by another under license from you?
- Yes
- No
Have you previously had or are you now engaged in any disputes with any of your licensors or product suppliers (manufacturers)?
- Yes
- No
If "Yes", please give details.
How many end uses are there for the MPMW to be insured?
Do the MPMW:
Involve the use of relatively scarce raw materials?
- Yes
- No
Require special manufacturing equipment?
- Yes
- No
Involve the use of extraordinary or scarce labor skills?
- Yes
- No
Have any special power, fuel, energy, water or environmental requirement?
- Yes
- No
Generate toxic wastes or involve hazardous conditions?
- Yes
- No
Are any confidential trade secrets or know-hows used in any process/invention/device or MPMW to be insured?
- Yes
- No
Would you consider taking a license on the MPMW to be insured if you were likely to be found to infringe on another’s intellectual property rights?
- Yes
- No
Are there presently, in the market, similar or competing alternatives to the MPMW to be insured?
- Yes
- No
If “Yes”, are there patent, trademark or copyright numbers, symbols, or pending notices on such devices?
- Yes
- No
If "Yes", please give the numbers.
Estimate the number of companies that directly compete with your MPMW in the marketplace.
- None
- Less than 5
- 5-10
- 10-20
- More than 20
Indicate the names of your top five (5) closest competitors and their geographic market (US and/or foreign). Include yourself.
If any of the above competitors are likely to hold patents, trademarks or copyrights on their products, please list which ones:

Categorize your company and the top five (5) competitors with regard to Total Sales:

#1 Company and its Estimated Total Annual Sales	#2 Company and its Estimated Total Annual Sales	#3 Company and its Estimated Total Annual Sales	#4 Company and its Estimated Total Annual Sales	#5 Company and its Estimated Total Annual Sales	Applicant's Company and Estimated Total Annual Sales

Your Sales in the Previous Year:

US	Foreign	Total

Your Sales in the Current Year:

US	Foreign	Total

Your Sales in the Next Year:

US	Foreign	Total

Please attach a current financial statement, audited if available, and/or Form 10K, if publicly traded.
Max. file size: 50 MB.
What is the average market life of the MPMW?
- Less than 1 year
- 1-3 years
- 3-5 years
- 5-10 years
- Over 10 years
Estimate the total size of the U.S. market for the MPMW to be insured.
- Less than $1M
- $1M - $10M
- $10M - $100M
- $100M - $500M

List each company and the number of years the product or process to be insured has been used or sold by you and your competitors:

#1 Company and Number of Years	#2 Company and Number of Years	#3 Company and Number of Years	#4 Company and Number of Years	#5 Company and Number of Years	Applicant's Company and Number of Years

Who are the principal customers served by Your business?
Does your business involve “aftermarket supply” or re-seller market (e.g., automotive replacement parts, printer ink replacement, long distance telephone re-seller)?
- Yes
- No
Please give details for the above.
Estimate the average % Net Profit (before interest and taxes) experienced by your company, for the company as a WHOLE.
- Less than 5%
- 5% - 10%
- 10% - 20%
- 20% - 40%
- More than 40%
Estimate the average % Net Profit (before interest and taxes) experienced by your company, for INSURED MPMW ONLY.
- Less than 5%
- 5% - 10%
- 10% - 20%
- 20% - 40%
- More than 40%
Have you ever been a Defendant in a patent, trademark or copyright infringement lawsuit?
- Yes
- No
If "Yes", please provide details.
Do you have an intellectual property attorney on staff with full time responsibilities for filing PATENTS, TRADEMARKS, or COPYRIGHTS, giving advice about potential infringements and other intellectual property legal advice?
- Yes
- No
If "Yes", please provide the name(s) of the attorney(s).
Do you have an outside, independent law firm that regularly provides you intellectual property legal advice?
- Yes
- No
If "Yes", please provide the name of the law firm, its address, and the attorney who is your contact.
Do you use confidentiality/non-compete agreements in all your IP negotiations?
- Yes
- No

What are your average IP related defense costs for the last three years?

Last Year	2 Years Ago	3 Years Ago

Are you aware of any facts or circumstances not otherwise disclosed on this application which could reasonably increase the likelihood that another party might accuse you of infringing upon its intellectual property?
- Yes
- No
If "Yes", please provide details.
SPECIFIC IP DEFENSE COVERAGES
The questions following pertain to the specific IP defense coverages you wish to purchase. Please answer only those that apply (e.g. if you are only insuring against patent infringement charges, then answer ALL of the questions which relate to “Patents” and skip the ones which relate to Trademarks and Copyrights).
Questions for coverage against charges of “PATENT” infringement:
As part of this application, we request a copy of any infringement search and opinion(s) (freedom to manufacture opinion) from outside counsel. Include references cited, if any. If you need a sample format for this search & opinion, please notify us for a copy of the format. We may also be able to assist you in obtaining this search & opinion, or an alternative insurability report which will satisfy our underwriting requirements.
Product/Process Name for which insurance is being requested:
Please attach any literature you may have describing your product/process. It is important that we have a clear understanding of the MPMW you wish to insure.
Max. file size: 50 MB.
Date of first commercial sales:
MM slash DD slash YYYY
Do you hold PATENTS, PATENT applications, or anticipate filing a PATENT application(s) on the product/process to be insured?
- Yes
- No
If "Yes", please provide a brief explanation of the inventive features covered.
List your ten (10) most important PATENTS and their numbers:
Are the PATENTS listed above licensed to anyone?
- Yes
- No
If “Yes”, please identify Licensee and type of license (i.e. exclusive, non-exclusive, sole, territorial, products/processes, payments, royalties, duty to enforce, defend, etc.).
Are you obligated to defend any third party for patent infringement vis-à-vis the product being insured?
- Yes
- No
If "Yes", please identify:
Are any products/processes (MPMW) to be insured licensed by you TO others (i.e. you are the licensor)?
- Yes
- No
If "Yes", please identify.
Are any products/processes (MPMW) to be insured licensed by you FROM others (i.e. you are the licensee)?
- Yes
- No
If "Yes", please identify.
In designing your product, did you copy or design around any third party patents?
- Yes, copied
- Yes, designed
- Neither
*check all that apply
If "Yes" to either, please identify patent number(s):
Do you have knowledge of existing infringements of the product/process to be insured either in the U.S. or in foreign countries of patents of others? (For example, are you currently using any patented features of another without their authorization?)
- Yes
- No
If “Yes”, please provide details, including the name of the other party and date you intend to begin this use.
Do you have knowledge of suspected or anticipated infringements of other’s patent rights? For example, do you anticipate or are you about to use the patented features of another without their authorization?
- Yes
- No
If “Yes”, please provide details, including the name of the other party and date you intend to begin this use.
Do you have knowledge of activities outside the U.S. which if conducted in the U.S. would be an infringement? For example, are you using any patented features of another overseas without their authorization?
- Yes
- No
If “Yes”, please provide details, including the name of the other party and date you first began this use.
Have you received any warning letters or notices of infringement from anyone concerning the product to be insured?
- Yes
- No
If "Yes", please attach copies.
Max. file size: 50 MB.
Have you been offered and have refused a license covering any of the products to be insured?
- Yes
- No
If “Yes”, please provide details, including name(s).
Are there any circumstances of which the Applicant is aware (including existing or threatened lawsuits) that could reasonably be expected to give rise to IP litigation against the Applicant?
- Yes
- No
If "Yes", please provide details.
Is this policy being sought to cover any MPMW loss, costs or expenses vis-à-vis filing an abbreviated or new drug application (ANDA or NDA) with the FDA under the Hatch Waxman Act?
- Yes
- No
If "Yes", please provide details.
Has the MPMW ever been involved in any Hatch Waxman proceedings?
- Yes
- No
If "Yes", please provide details.
Indicate the number of patents held/controlled/licensed by you.
Questions for Coverage Against Charges of "TRADEMARK" infringement
*As part of this application, we request a copy of any infringement search and opinion(s) (freedom to use opinion) from outside counsel. Include references cited, if any. If you need a sample format for this search & opinion, please notify us for a copy of the format. We may also be able to assist you in obtaining this search & opinion or an alternative insurability report which will satisfy our underwriting requirements.
Identify a list of the marks, symbols, designations or TRADE DRESS you own, control or license (MPMW) for which you would like coverage. T/M registration number (if applicable) or identifying features of symbol, mark, designation or trade dress (MPMW). Add the registration date (if applicable), the date the sales began and the country.
Please also attach any literature describing your MPMW to be insured. It is important that we have a clear understanding of the MPMW you wish to insure.)
Max. file size: 50 MB.
Indicate the number of TRADEMARKS held/controlled/licensed by you.
Do you have an obligation to defend a third party vis-à-vis the marks, symbols, designations or TRADE DRESS (MPMW) to be insured?
- Yes
- No
If "Yes", please identify party or parties.
Are any marks, symbols, designations or TRADE DRESS (MPMW) to be insured licensed by you to others (i.e. you are the licensor)?
- Yes
- No
If "Yes", please identify party or parties.
Are any marks, symbols, designations or TRADE DRESS (MPMW) to be insured licensed by you from others (i.e. you are the licensee)?
- Yes
- No
If "Yes", please identify party or parties.
Has anyone else registered the same or a similar mark, symbol, designation or TRADE DRESS (MPMW) in a different class?
- Yes
- No
If "Yes", please list the classes and the owners.
Is any part of the MPMW to which the marks, symbols, designations or TRADE DRESS to be insured are applied covered by COPYRIGHT(s) or PATENT(s)?
- Yes, Copyright(s)
- Yes, Patent(s)
- Neither
*check all that apply
Does anyone else have a right in the marks, symbols, designations or TRADE DRESS (MPMW) to be insured?
- Yes
- No
If "Yes", please identify party or parties.
Have you notified anyone that the marks, symbols, designations or TRADE DRESS (MPMW) for which insurance is sought are infringed by them?
- Yes
- No
If "Yes", to whom?
Do you have knowledge of existing infringements of the MPMW to be insured either in the U.S. or in foreign countries of trademarks of others? For example, are you currently using any trademark of another without their authorization?
- Yes
- No
If “Yes”, please provide details, including the name of the other party and date you first began this use.
Do you have knowledge of suspected or anticipated infringements of other’s trademark rights? For example, do you anticipate or are you about to use a trademark of another without their authorization?
- Yes
- No
If “Yes”, please provide details, including the name of the other party and date you intend to begin this use.
Do you have knowledge of activities outside the U.S. which if conducted in the U.S. would be a trademark infringement? For example, are you using any trademark of another overseas without their authorization?
- Yes
- No
If “Yes”, please provide details, including name of other party and date you first began this use.
Have you received any warning letters or notices of infringement from anyone that you might be infringing their trademark?
- Yes
- No
If "Yes", please attach copies.
Max. file size: 50 MB.
Have you received offers for license under any trademark of another which you have refused or denied?
- Yes
- No
If "Yes", please provide details.
Are any of your TRADEMARKS famous?
- Yes
- No
If "Yes", please list the trademarks and describe their fame.
Are you aware of any famous trademarks that are similar to any of your TRADEMARKS, even if they are in a different area of commerce?
- Yes
- No
If “Yes”, please list and describe those trademarks and their relationship to your area of commerce.
Questions for Coverage Against Charges of "COPYRIGHT" Infringement
Identify below the Works of Authorship you own, control or license (MPMW) for which you would like coverage. Include COPYRIGHT Registration Number (if applicable) and a list of identifying features of Works of Authorship (MPMW). Include the registration date (if applicable), the date sales began and the country.
Please also attach any literature describing your MPMW to be insured, It is important that we have a clear understanding of the MPMW you wish to insure.
Max. file size: 50 MB.
Indicate the number of COPYRIGHTS held/controlled/licensed by you.
Do you have an obligation to defend a third party vis-à-vis the Works of Authorship (MPMW) to be insured?
- Yes
- No
Are any Works of Authorship (MPMW) to be insured licensed by you to others (i.e. you are the licensor)?
- Yes
- No
If "Yes", please identify party or parties.
Are any Works of Authorship (MPMW) to be insured licensed by you from others (i.e. you are the licensee)?
- Yes
- No
If "Yes", please provide copies of licensee(s) or written permission(s).
Max. file size: 50 MB.
Has anyone else registered or asserted copyright rights in the same or similar Works of Authorship (MPMW) in a different class?
- Yes
- No
If "Yes", please list classes and owners.
Is any part of the MPMW to which the Works of Authorship to be insured covered by TRADEMARK(s) or PATENT(s)?
- Yes, Trademark(s)
- Yes, Patent(s)
- No, neither
*check all that apply
Does anyone else have a right in the Works of Authorship (MPMW) to be insured?
- Yes
- No
If "Yes", please identify party or parties.
Have you notified anyone that the Works of Authorship (MPMW) for which insurance is sought are infringed by them?
- Yes
- No
If "Yes", to whom?
Do you have knowledge of existing infringements of the MPMW to be insured either in the U.S. or in foreign countries of copyrights of others? For example, are you currently using any Works of Authorship of another without their authorization?
- Yes
- No
If “Yes”, please provide details, including the name of the other party and date you first began this use.
Do you have knowledge of possible infringement of the MPMW to be insured? For example, are you about to use Works of Authorship similar to those of another without their authorization?
- Yes
- No
If “Yes”, please provide details, including the name of the other party and date you intend to begin this use.
Do you have knowledge of activities outside the U.S. which, if conducted in the U.S., would be a copyright infringement? For example, are you using any Works of Authorship of another overseas without their authorization?
- Yes
- No
If “Yes”, please provide details, including the name of the other party and date you first began this use.
Have you received any warning letters or notices of infringement from anyone that you might be infringing their copyright?
- Yes
- No
If "Yes", please submit copies.
Max. file size: 50 MB.
Have you received offers for license under any copyright of another which you have refused or denied?
- Yes
- No
If "Yes", please provide details.
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Commercial – Intellectual Property (IP)

Get started by filling out this form and someone from our team will contact you shortly!

Commercial - Intellectual Property (IP)

CLIENT INFORMATION

UNDERWRITING INFORMATION

Indicate if you or your Company have been involved in any of the following:

MPMW

Do the MPMW:

SPECIFIC IP DEFENSE COVERAGES

Questions for coverage against charges of “PATENT” infringement:

Questions for Coverage Against Charges of "TRADEMARK" infringement

Questions for Coverage Against Charges of "COPYRIGHT" Infringement