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Sample Permission Letter Form

The document is a sample permission request letter and form that seeks permission to reproduce an excerpt or illustration from a copyright holder's work in an upcoming published book. The letter provides details about the book being published, a description of the excerpt or illustration being requested, and requests permission to use it in all editions and formats of the book in exchange for a complimentary copy. The accompanying form is for the copyright holder to sign, granting or denying permission and specifying any reproduction fees or preferred credit lines.

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Phyu Zin Aye
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© Attribution Non-Commercial (BY-NC)
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218 views

Sample Permission Letter Form

The document is a sample permission request letter and form that seeks permission to reproduce an excerpt or illustration from a copyright holder's work in an upcoming published book. The letter provides details about the book being published, a description of the excerpt or illustration being requested, and requests permission to use it in all editions and formats of the book in exchange for a complimentary copy. The accompanying form is for the copyright holder to sign, granting or denying permission and specifying any reproduction fees or preferred credit lines.

Uploaded by

Phyu Zin Aye
Copyright
© Attribution Non-Commercial (BY-NC)
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
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SAMPLEPERMISSIONREQUESTLETTERANDFORM

[Adaptthislettertosendoutunderyourownletterheadwiththeaccompanyingform.Atthetopofthe
form,fillinthedescriptionoftheitemforwhichyouareseekingpermissionand,nearthebottom,your
proposedcreditline.Sendtwocopiesoftheletterandformtoeachrecipient,togetherwithaself
addressed,stampedenvelope.]
Dear[name],
Iamtheauthor[oreditor]ofthebook[title],tobepublishedbytheUniversityofBritish
ColumbiaPressin[seasonandyear].Iamwritingtoaskforyourpermissiontoreproducean
excerpt[oranillustration]inthispublication.
ThesourceinformationthatIhaveforthisexcerpt[orillustration]isasfollows:
[Foratext,givetheauthor,completetitle,completepublicationdetailsforthejournalorbookin
whichtheexcerptappeared,includingpagenumbers.Citethefirstandlastfewphrasesofthe
passageandindicatethetotalnumberofwords.]
[Foraphotograph,givethenameofthephotographerandabriefdescriptionofthesubjectofthe
photographor(whereapplicable)thecreatorandtitleoftheworkshowninthephotograph.For
anothertypeofillustration,suchasamapordiagram,orforatable,givecompletesource
informationasforatext,alongwithabriefdescriptionandthenameofthecreator,ifknown.]
Iamenclosingaphotocopyoftheexcerpt[ortheillustration].
TheUniversityofBritishColumbiaPressisanonprofit,academicpublishinghouse.[Booktitle]
isascholarlystudy,approximately[number]printedpagesinlength,whichwillbepublished
inaneditionof[number]copies.Itwillbesoldtolibraries,scholars,andinterestedgeneral
readers.
Iamrequestingpermissiontoreproducetheexcerpt[ortheillustration]inalleditionsand
formatsrelatedtothisbook,includingelectronic,forthedurationofthepublication,andin
printandonlineadvertisingandmarketingmaterialspromotingthebook.
Please note that a credit line will appear prominently in the book acknowledging
that the material is used with the permission of the copyright holder.
[IFAPPLICABLE]:Ialsorequestpermissiontoreproducetheillustrationonthecoverofthe
bookandinmaterialsadvertisingandpromotingthebook.
[IFAPPLICABLE]:Iwillreceivenoroyaltiesonthefirsteditionofthebook.]Iwouldbemost
gratefulifyoucouldwaiveanyreproductionfees;inreturnforthiscourtesy,Icanofferyou
onecomplimentarycopyofthebook.
Pleasecompleteonecopyoftheenclosedform,signit,andreturnittomeatyourearliest
convenience,togetherwithonecopyofthisletter.Thesecondcopiesoftheformandtheletter
areforyourrecords.Youmayfaxthecompletedformandlettertomeat[faxnumber].

Thankyouverymuchforyourhelpinthismatter.Ifyouhaveanyquestions,pleasecallmeat
[phonenumber]oremailyourqueryto[emailaddress].

Descriptionofitem:[asspecifiedonthefirstpageofthisletter]:

Pleasecompletethispageandreturnonecopytome,togetherwiththeattachedletter.A
secondcopyisenclosedforyourconvenience.
Pleasecheckone:
I/weclaimnorightsinthiswork.
OR
I/weclaimfullrightsinthiswork.
OR
I/weclaimonlythefollowingrightsinthiswork:

Forotherrights,pleasecontact(name):
(address):
Pleasecheckone:
I/wewaiveanyfee,inexchangeforonecomplimentarycopyofthebook.
OR
Thefeeforuseinthebookis$

,payableonpublicationofthebook.
Thefeeforuseonthecoveris$

,payableuponpublication.
Thefeeforuseinadvertisingandpromotingthebookis$

,payable
uponsuchuse.

Pleasecheckone:
Thefollowingcreditlineisacceptable[Applicant:insertproposedcreditlinehere]:
OR
I/wepreferthefollowingcreditline:

Foraworkofart,pleasespecifymedium,dimension,date,andlocation:

I/weherebygrantpermissionfortheuseofthisitemasoutlinedintheaccompanyingletter.
I/wewarrantthatI/wehavethelegalauthoritytogranttherightsspecified.

Signature:

Date:

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