PRODUCT PLACEMENT DISCLOSURE FORM

 Update: Nov. 1, 2025

1) What is it?

A concise disclosure certificate used in legal delivery to identify every on-screen product, brand, or logo—visual or verbal—appearing due to paid product placement or guaranteed use (even without payment). If no such placements exist, the producer confirms a negative disclosure by marking “No Product Placement” or “NONE.” The form documents consideration received, guarantees, and whether underlying placement agreements/releases have been delivered, giving distributors clear marketing, compliance, and E&O audit trails.

2) Who is this for?

·       Producers/Licensors finalizing delivery and clearing marketing/compliance risk

·       Distributors/Sales Agents/Platforms validating advertising and promotional permissions

·       Business & Legal Affairs / E&O Insurers verifying disclosures, consideration, and paper trail

·       Post Supervisors/Delivery Managers aligning timecodes, screenshots, and documentation

3) What does it include?

·       Submission Instructions: Email completed form to [company email]; complete negative confirmation if no placements exist (“No Product Placement” / “NONE”).

·       Title of Production: Official production title; season/film identifiers.

·       Placement Details (row-based, one line per placement):

o   Type of Placement (hands-on/hero, background, verbal mention, logo only, signage, wardrobe, prop, set dressing)

o   Episode(s) (if applicable)

o   Timecode In/Out (first/last frame of visibility or audible mention)

o   Description of Placement and/or Screenshot (brief scene summary; attach stills)

o   List of Company / Brand(s) / Sub-brand(s) / Logo(s) Appearing (exact names, stylization)

o   Consideration Received for Placement AND/OR No Consideration, but Guaranteed Placement (☑ one; disclose cash, in-kind, loaned gear, services, promotional value)

·       Deal Paperwork Status:

o   Product Placement Agreement and/or Product Release Previously Delivered to Company ☑ (attach if not already delivered)

·       Certification Block: Authorized signatory name, title, company, signature, date; contact info for follow-up.

·       Notes/Exceptions (optional): Exclusivity promises, blackout restrictions, embargoes, credit obligations, co-marketing deliverables, or pending paperwork with expected delivery dates.

DISCLAIMER:

·      This document template is provided for educational and informational purposes only and does not constitute legal advice. Use at your own risk.

·      Use of this document does not create an attorney-client relationship, privilege, or confidentiality.

·      You are responsible for customizing this template to your own needs.

·      You should consult with a qualified attorney licensed in your jurisdiction to satisfy your specific legal needs.

·      We do not provide advice specific to your situation.

·      This document is for a single business use only.

·      There are no warranties or representations as to the accuracy of the form and no  assumptions of liability or responsibility for any errors or omissions.

·      This information is presented on an “as is” basis.

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