v.

07-2012

Filipinas Heritage Library

Filipiniana Section
Photo Archive
Authorization Number
Photo Order Form
Requested By: Romain Garry Lazaro Date: January 20, 2020
Institution:
Address:
Tel/Cell No.: 0906 240 5317 Email: romaingarrylazaro@gmail.com

1 Usage Fee
Purpose Unit Price (Php) Qty Amount Total Amount
Research/Non-profit/educational 200.00 1 200.00 PHP 200.00

TITLE :
DATE OF RELEASE/PUBLICATION / PRINT RUN :
CHANNEL (if for TV Documentary, Ad, etc) :

2 Scanning / Enhancement Fee Contemporary Materials Rare Materials

Qty Amount Qty Amount
Scanning < A4 50.00 - - 100.00 - -
< 1ft x 1ft 100.00 - - 150.00 - -
< 2ft x 2ft 150.00 - - 200.00 - -
< 3ft x 3ft 200.00 - - 250.00 - -
< 4ft x 4ft 250.00 - - 300.00 - -
> 4ft x 4ft 300.00 - - 350.00 - -
Tota Amount PHP - Total Amount PHP -

3 Storage Media
Unit Price Qty Amount
CD-R (with single CD case) 20.00 - PHP -

Print Format Black & White Color

Total Amount
Sizes Unit Price Qty Amount Unit Price Qty Amount
4x5 50.00 - - 100.00 - - PHP -
5x7 75.00 - - 125.00 - -
8 x 10 150.00 - - 200.00 - -
10 x 15 200.00 - - 300.00 - -

5 Shipping Unit Price Qty Total Amount

For 1st 500 grams - - PHP -

6 Bank Charges Unit Price Qty Total Amount

Transaction Fee - - PHP -
Sub-Total + 12% VAT: 178.57 + 21.43
PhotoID Notes Total: PHP 200.00
RE00108 For research purposes only Discount:
Grand Total: PHP 200.00
Receipt No.:
Date Due:
Prepared by:

Date Claimed:
Claimed by:
Receipt No.:

Terms and Conditions

The undersigned understands and is agreeable to the following terms and conditions which bind this authorization:

1. The photograph/s or the digital copies of the images in the Photo Archive of the Filipinas Heritage Library must be used for a single time only, which is solely for the
purpose indicated. The requesting party must be specific with its purpose for and intended use of the images. It must also identify the alterations, if there are any, which it
intends to effect on the images. Authorization must be secured from the owner of the images and corresponding reproduction fees must be paid for each use in and per
edition of any publication containing reproductions from the Filipinas Heritage Library.

2. The authorization given by Filipinas Heritage Library to use material/s from its collection does not grant the user copyright or any intellectual property
rights. The requesting individual or institution is expected to obtain permission from the copyright holder.
3. The Filipinas Heritage Library may want to procure at least one (1) copy of the publication (print, online, multimedia, video) produced by the requesting party and which
contains the images from the FHL Photo Archive. FHL may get in touch with undersigned / publisher using the following contact info ________________________.
Requesting party should also inform the library of the release or launch of the publication.

4. Agreements governing the use of these images will be governed by the terms and conditions stipulated in the Photo Order Form. Some of the terms and conditions of
the agreement may be specific to the requesting party so that the contract for the use of the images is non-transferable. It will instead be considered a new project.

5. Processing of orders will be made upon payment of the deposit fee. The requesting party may also settle the payment in lump sum, after which the order will be
processed. Requesting party may expect the reproductions within three (3) to five (5) days, unless the volume of the order does not permit a 3-to-5-days turnover. With
check payments, orders will be processed as soon as the check clears.

6. Contract for the use of the reproductions will be applicable for a period of one (1) year only. The Photo Archive of the Filipinas Heritage Library will NOT resend
reproductions acknowledged to have been received or/then lost or misplaced by the requesting party.

7. The Filipinas Heritage Library or Ayala Foundation Inc. shall not be liable for any use contrary to law of reproductions from the Library.

Conforme
 v. 07-2012

Filipinas Heritage Library

Filipiniana Section
Photo Archive
Authorization Number
Photo Claim Form
Requested By: Romain Garry Lazaro Date: January 20, 2020
Institution:
Address:
Tel/Cell No.: 0906 240 5317 Email: romaingarrylazaro@gmail.com

Sub-Total + 12% VAT: 178.57 + 21.43

PhotoID Notes Total: PHP 200.00
RE00108 For research purposes only Discount -
Grand Total: PHP 200.00
Receipt No.:
Date Due:
Prepared by:

Date Claimed:
Claimed by:
Receipt No.:

Terms and Conditions

The undersigned understands and is agreeable to the following terms and conditions which bind this authorization:

1. The photograph/s or the digital copies of the images in the Photo Archive of the Filipinas Heritage Library must be
used for a single time only, which is solely for the purpose indicated. The requesting party must be specific with its
purpose for and intended use of the images. It must also identify the alterations, if there are any, which it intends to effect
on the images. Authorization must be secured from the owner of the images and corresponding reproduction fees must
be paid for each use in and per edition of any publication containing reproductions from the Filipinas Heritage Library.

2. The authorization given by Filipinas Heritage Library to use material/s from its collection does not grant the
user copyright or any intellectual property rights. The requesting individual or institution is expected to obtain
permission from the copyright holder.

3. The Filipinas Heritage Library may want to procure at least one (1) copy of the publication (print, online, multimedia,
video) produced by the requesting party and which contains the images from the FHL Photo Archive. FHL may get in
touch with undersigned / publisher using the following contact info ________________________. Requesting party
should also inform the library of the release or launch of the publication.
4. Agreements governing the use of these images will be governed by the terms and conditions stipulated in the Photo
Order Form. Some of the terms and conditions of the agreement may be specific to the requesting party so that the
contract for the use of the images is non-transferable. It will instead be considered a new project.
5. Processing of orders will be made upon payment of the deposit fee. The requesting party may also settle the payment
in lump sum, after which the order will be processed. Requesting party may expect the reproductions within three (3) to
five (5) days, unless the volume of the order does not permit a 3-to-5-days turnover. With check payments, orders will be
processed as soon as the check clears.

6. Contract for the use of the reproductions will be applicable for a period of one (1) year only. The Photo Archive of the
Filipinas Heritage Library will NOT resend reproductions acknowledged to have been received or/then lost or misplaced
by the requesting party.
7. The Filipinas Heritage Library or Ayala Foundation Inc. shall not be liable for any use contrary to law of reproductions
from the Library.

Conforme