MODEL RELEASE AND CONSENT FORM
This Model Release and Consent Form (this "Release") is executed pursuant to the relevant provisions of Republic Act No. 386, otherwise known as the Civil Code of the Philippines, Republic Act No. 8293 (the Intellectual Property Code of the Philippines), and Republic Act No. 10173 (the Data Privacy Act of 2012), and pertains to the following photographs and/or images (the "Work"):
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§ 1. Parties. I, ________, of legal age, Filipino, with government-issued identification number ________, and with residential address at ________ (the "Model"), in favor of ________, of legal age, with government-issued identification number ________, and with address at ________ (the "Publisher"), together with any officers, employees, directors, agents, contractors, assignees, licensees, transferees, successors, legal representatives, or other representatives of the Publisher (the "Publisher's Representatives"), do hereby execute this Release upon the following terms and conditions.
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§ 3. Consideration. I acknowledge receipt of valuable consideration in the amount of ________, the sufficiency of which is hereby acknowledged, as full and adequate consideration for the rights, consents, waivers, and releases granted herein.
§ 4. Data Privacy Consent. In accordance with Republic Act No. 10173 (the Data Privacy Act of 2012) and its Implementing Rules and Regulations, I hereby give my free, voluntary, informed, and specific consent to the collection, recording, processing, storage, use, and disclosure by the Publisher and the Publisher's Representatives of my personal information and my image as contained in or arising from the Work, for the purposes set forth in this Release. I acknowledge that I have been informed of my rights as a data subject, including the rights to access, to rectification, to object, and to erasure or blocking, subject to the limitations provided by law.
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§ 6. Ownership of Rights. I acknowledge that all right, title, and interest in or relating to the Work, including the copyright therein, belongs absolutely to the Publisher in accordance with the Intellectual Property Code of the Philippines. I waive any and all rights to inspect, approve, or otherwise review any use of the Work featuring me, my image, my likeness, or my property.
§ 7. Binding Effect. This authorization, waiver, and release shall inure to the benefit of the legal representatives, licensees, heirs, successors, and assigns of the Publisher and shall be binding upon me, my heirs, assignees, and legal representatives.
§ 8. Warranties. I hereby warrant and represent that I am of legal age and possess full legal capacity to contract in my own name in connection with this Release; that I have read and fully understand the contents hereof; and that no inducements, statements, or representations other than those expressly set forth herein have been made to me.
§ 9. Entire Agreement and Severability. This Release contains the entire understanding between me and the Publisher and supersedes all prior agreements relating to its subject matter. Should any provision hereof be declared invalid or unenforceable, the remaining provisions shall continue in full force and effect.
§ 10. Governing Law and Venue. This Release shall be governed by and construed in accordance with the laws of the Republic of the Philippines. Any dispute arising herefrom shall be submitted to the exclusive jurisdiction of the proper courts of ________.
IN WITNESS WHEREOF, I have hereunto set my hand this ________ day of ________ at the City/Municipality of ________, Province of ________, Philippines.
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Model
Signed in the presence of:
________ ________
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )
CITY/MUNICIPALITY OF ________ ) S.S.
BEFORE ME, a Notary Public for and in the above jurisdiction, this ________ day of ________, personally appeared the above-named Model, ________, who exhibited to me his/her competent evidence of identity in the form of ________ with number ________, known to me and to me known to be the same person who executed the foregoing instrument, and who acknowledged to me that the same is his/her free and voluntary act and deed.
This instrument consists of ________ pages, including the page on which this acknowledgment is written, and is signed by the party and his/her instrumental witnesses on each and every page hereof.
WITNESS MY HAND AND SEAL on the date and at the place first above written.
Doc. No. ________;
Page No. ________;
Book No. ________;
Series of ________.