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Permissions Request Form: Material To Be Reproduced

This document is a permissions request form seeking non-exclusive permission to reproduce copyrighted materials like articles, excerpts, figures or tables. The form requests details about the copyrighted material, rights required, and forthcoming publication. It must be signed by both the requestor and permission granter.

Uploaded by

ANSuciZahra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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148 views2 pages

Permissions Request Form: Material To Be Reproduced

This document is a permissions request form seeking non-exclusive permission to reproduce copyrighted materials like articles, excerpts, figures or tables. The form requests details about the copyrighted material, rights required, and forthcoming publication. It must be signed by both the requestor and permission granter.

Uploaded by

ANSuciZahra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Permissions

Request Form

(author name)            is seeking non-exclusive permission to reproduce the following copyrighted item/s

Material to be reproduced:

Journal, Series,
Serial or Book Title      
Volume Title      
Chapter/Article Title      
Author/s      
No. of items to be
reproduced       Year of Publication      
Type of Item to be
Figure Table Illustration Excerpt
reproduced
Name of Item      
Page Number of Excerpt word count
Item       (if applicable)      
Excerpt text      
(if applicable)

Rights Required:
 Print and Electronic – All of the above able to include sublicensing, without charge, of publication or transcription in Braille,
large-type editions, or recordings for the blind and other special editions for use by the physically handicapped by
approved non-profit organisations, only if such edition is neither sold nor rented for a fee
 Worldwide English Language Rights only
 To use the material for the life of the work (i.e. there should be no time restrictions on the reuse of material, e.g. one-year
licence granted)
Details of Forthcoming Publication by Emerald Group Publishing Limited:

Journal, Series,
Serial or Book Title      
Journal or Series
Editor/s      
Volume Title and
Number      
(if applicable)

Article/Chapter Title      


Author/s      
Publication Date
(approx)      
Page Count       Print Run      
Format
(print/electronic)       Price      
Publisher EMERALD GROUP PUBLISHING LIMITED
Please confirm permission to reproduce the materials as outlined above by signing the attached document and returning either
by e-mail or fax to:

FAO       FAX       E-MAIL      


If you do not control these rights in their entirety please let me know to whom this query should be directed.
We agree to use standard acknowledgement of source or the acknowledgement lines you may wish to provide (please state
below)

     

Permission granted by:

Name      
Position      

Signature
(either hand-written or
insert a scanned
signature)

Date      

Permission requested by:

Name      
Address      

Signature
(either hand-written or
insert a scanned
signature)

Date      

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