PRODUCT PLACEMENT DISCLOSURE FORM

Update: July 1, 2026

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.

IF THERE ARE INSTRUCTIONS FOR THIS FORM:

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3. Not all forms have instructions.

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Re-Using the Form Template:

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NOTE: The PDF's do not save while filling them out. Save your entries on a separate document and then copy and paste the text into the PDF forms. Then print them out.

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