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Model Release - Signed

The document is a model release form providing details about a photo shoot, including information about the model, Fatiyyah Eka, and the artist, Poko Moto. It grants the artist rights to use photos from the shoot and limits the model and parent's ability to make future claims.

Uploaded by

AW Creative
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
11 views3 pages

Model Release - Signed

The document is a model release form providing details about a photo shoot, including information about the model, Fatiyyah Eka, and the artist, Poko Moto. It grants the artist rights to use photos from the shoot and limits the model and parent's ability to make future claims.

Uploaded by

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

Model

Printed name {{!model_name_es_:signer1


Fatiyyah Eka }}

Date of birth 13 Agust 2010


{{*model_dob_es_:signer1 }}

Gender Female
{{*model_gender_es_:signer1 }}

Ethnicity of the Model (Optional)

We use the information for descriptive purpose to provide better accuracy in assigning
search words

{{model_ethnicity_es_:signer1 }}

Information of Model (or Parents*)

Address Dsn wringincilik pulo village tempeh lumajang }}


{{*model_address_1_es_:signer1

Eats java Indonesia


{{model_address_2_es_:signer1 }}
For Consideration received and by signing this release, I irrevocably
grant to the Artist the right to license and use the Content in any manner,
form or medium, for any and all use whatsoever (except pornographic or Phone 082245546768
{{*model_phone_es_:signer1 }}
illegal), which may include art, advertising, promotion, marketing and
packaging for any product or service. I agree that:
Email [email protected]
{{!model_email_es_:signer1:email:isemail }}
the Content may be used in combination with other images and
may be modified;
By signing below, i agree to the terms of this release.
I have no rights to inspect or approve the Content or the use to
which the Content may be applied; Signature of Model (or Parents*)
I have no further right to additional Consideration and will not
make claims associated to the Content, for any reason, to the
Artist.
{{*model_sign_es_:signer1:signature
Arif Wahyu (Jan 2, 2024 14:48 GMT+7)
}}

I agree that my personal information will not be made publicly available


Date of Signature Jan 2, 2024
{{*model_sign_date_es_:signer1:date }}
but may only be used in connection to licensing the Content where
necessary (e.g., to defend claims and protect legal rights), and may be
retained as long as necessary to fulfill this purpose, including by being
shared with sub-licensees and assignees of the Artist and transferred to * If Model is a minor or lacks capacity where she resides, the parent or legal guardian of
countries with differing data protection and privacy laws where it may be the Model agrees to this release on behalf of the Model.
stored, accessed and used. Name of Parent or Legal Gaurdian

Deti Kusumawati
{{model_parent_name_es_:signer1 }}
I release, discharge, and agree to hold harmless the Artist and her
licensees, sub-licensees, successors, and assigns (“Released Parties”)
from any liability arising out of or in connection with the use of the
Content, including any and all claims for defamation or invasion of Artist Information
privacy or publicity. I acknowledge that the Released Parties are not
responsible or liable for any unauthorized use or piracy of the Content. Signature {{*artist_sign_es_:signer2:signature}}
Poko Moto (Jan 2, 2024 15:10 GMT+7)

I represent and warrant that I am at least 18 years of age and have the
Printed name Poko Moto
{{*!artist_name_es_:signer2:fullname }}
full legal capacity to execute this release on my own behalf, or on the
behalf of a minor as their parent or legal guardian. I acknowledge and
agree that this release is binding upon my heirs and assigns. Date signed Jan 2, 2024
{{!artist_sign_date_es_:signer2:date }}

Definitions
Recording session (Optional)
"Artist" means any person or entity photographing, filming, or
recording Content by any means during the recording session,
including Artist’s licensees, successors, and assigns. Description & Location {{!recording_desc_es_:signer1
Lumajang, Eats Java }}

"Consideration" means something of value I received in


Date of Recording
exchange for the rights granted in this release. {{!recording_date_es_:signer1
Jan 1, 2024 }}
Session(s)
"Content" means still or motion photographs or films,
illustration, animation, audio, or other recordings taken of me,
including my appearance, likeness, and voice during the
recording session.
Model Release
Final Audit Report 2024-01-02

Created: 2024-01-02

By: Adobe Stock ([email protected])

Status: Signed

Transaction ID: CBJCHBCAABAAKGgX77J37eIopfXOPIq3rfqv_yDWN8Zg

"Model Release" History


Document created by Adobe Stock ([email protected])
2024-01-02 - 7:28:08 AM GMT- IP address: 34.252.131.152

Document emailed to Arif Wahyu ([email protected]) for signature


2024-01-02 - 7:28:15 AM GMT

Email sent to Adobe Stock ([email protected]) bounced and could not be delivered
2024-01-02 - 7:28:44 AM GMT

Email viewed by Arif Wahyu ([email protected])


2024-01-02 - 7:45:21 AM GMT- IP address: 66.249.84.71

Document e-signed by Arif Wahyu ([email protected])


Signature Date: 2024-01-02 - 7:48:53 AM GMT - Time Source: server- IP address: 182.1.96.252

Document emailed to [email protected] for signature


2024-01-02 - 7:48:54 AM GMT

Email sent to Adobe Stock ([email protected]) bounced and could not be delivered
2024-01-02 - 7:49:19 AM GMT

Email viewed by [email protected]


2024-01-02 - 8:09:28 AM GMT- IP address: 66.249.84.68

Signer [email protected] entered name at signing as Poko Moto


2024-01-02 - 8:10:03 AM GMT- IP address: 114.125.111.104

Document e-signed by Poko Moto ([email protected])


Signature Date: 2024-01-02 - 8:10:05 AM GMT - Time Source: server- IP address: 114.125.111.104

Agreement completed.
2024-01-02 - 8:10:05 AM GMT

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