NSAI/Frost Music Professional Liability Program

1) Applicant Information
First Name:		Last Name:
Address:		City
State:		Zip
Phone:		Fax
E-mail:		Web site:
Year Established:		Type

2) Gross Annual Revenues from song writing/composing activities:
United States	$	Canada
International	$	(Country)

3) Is Applicant member of / represented by
ASCAP \| BMI \| SESAC \| OTHER

4) Does Applicant own a publishing company
Yes \| No \| If "Yes", is company actively engaged in music publishing Yes \| No

5) Number of:	Compositions written/produced in the past year Songs/lyrics written/produced in the past year

6) Percentage of songs or corporations that are:
Children's Classical Country Folk Hard Rock Jazz	Pop Religious Rythym & Blues Rock Serious (Opera, Chorale, etc.) Other (Describe below) Other?

7) Applicant's top revenue generating works and dates of release (if any):


8) If you have an existing song library, list all existing songs, by title, to be covered:
List song titles and check if song has been published.
1) \| 2) \| 3) \| 4) \| 5) \| 6) \| 7) \| 8) \| 9) \| 10) \|		11) \| 12) \| 13) \| 14) \| 15) \| 16) \| 17) \| 18) \| 19) \| 20) \|
Do you have more songs? Yes \| If so, please provide full list by email or fax a catalogue (615.322.9272).

9) Clearance Procedures and Operations:
a) Does Applicant sample other music? Yes \| No If so, please send a description of the policies and procedures utilized in connection with music sampling to: Frost Specialty, LLC 1117 17th Avenue South Nashville, TN 37212 b) Does Applicant maintain written contracts or agreements with persons co-writing/composing original music, lyrics, etc? Yes \| No If 'Yes' (above), does the contract wording include a mutual hold harmless agreement Yes \| No

10) Insurance and Claim Information
Has Applicant commenced suit, been sued or threatened with litigation in the past 10 years? Yes \| No If 'Yes', you will be contacted by the Agent regarding details of any claims. Does Applicant know of any situation that could give rise to any claims? Yes \| No If 'Yes', you will be contacted by the Agent regarding details of any claims.