Fondazione Torino Musei

1

Art Library and Photographic Archive

Via Magenta 31, 10128 Turin, Italy

AUTHORIZATION TO REPRODUCE THE ASSETS BELONGING TO THE HISTORICAL, ARTISTIC, ARCHAEOLOGICAL AND ARCHITECTURAL HERITAGE OF THE MUSEUMS APPOINTED TO THE FONDAZIONE TORINO MUSEI

Authorization is requested by

Applicant:______

(Fully indicate fiscal data: Name or Business Name, Fiscal Code Number and IVA (VAT) Number. N.B. In the absence of these data this request will not be considered)

Postal address: Street ______Number______

Postal code______Town ______Province ______Nation______

Telephone______

EMail______

Fiscal Code Number______

IVA (VAT) Number______

Intracommunity VAT Number______

To reproduce the works or places indicated here below (or enclosed)

1) ______

2) ______

3)______

4)______

5) ______

With the following characteristics and format

In Colour In B/W Inside the volume On the front and/or back cover

Full page In the same size or less than ¾ of a page

Use for which authorization is requested

Publication:______

(Indicate the type of publication: book, magazine, postcard, calendar, poster, playbill, brochure, CD-Rom, multimedia programme, Website, exhibition panel, gadget, etc…)

______

Title of the work______

(Publisher)______

(Author/Curator)______

Year______

(expected publication date)

Print run______

Language/s of the edition______

(in the case of a multi-language edition, indicate whether it is a single work in several languages, or several works each in one language)

______

Countries of distribution______

(indicate individual countries or “worldwide”)

List price______

Website address______

Remember that:

1) The Fondazione Torino Musei is the owner of every right inherent to the reproduction of any asset or part of one belonging to the heritage entrusted to the Foundation as provided by article 2 of the Convention signed with the City of Turin for the “Concession of use of assets entrusted to the management of the museum services”.

2) Authorization to reproduce the image is not understood as granted until the fee of concession is paid. The amount of the fee corresponds to the indications provided by the applicant; if modifications in number or subject were to occur, the applicant must inform the Foundation immediately; the latter will take steps to authorize the modifications and to adjust the concessionary fee accordingly, issuing a new invoice.

3) If in realizing products, using the images conceded, use of these images by third parties becomes necessary, the Concessionaire must inform the Foundation of the modes of transmission and use of these images by the third parties and must inform all third parties of all the conditions of use imposed by the Fondazione Torino Musei, and is, however, responsible for these images in all cases of violation of the obligations imposed.

Every default will be subject to prosecution on the basis of the laws in force.

The applicant declares he has examined the enclosed “Regulations for the reproduction of assets of the historical, artistic, archaeological and architectural heritage of the Museums appointed to the Fondazione Torino Musei”, which are here intended to be recalled in their entirety, and underwrites below the present request in complete acceptance of the same.

For the applicant ______

( Indicate Name, Surname, Title and Position of the signee)

Place and date______

Signature______

(Stamp and signature)

The Fondazione Torino Musei grants, ex article 3 of the enclosed Regulations, authorization to reproduce the images specified below (or listed in the enclosure) for the sole use declared.

______

______

Note______

Please remember that every example reproduced must indicate the specific details of the original work (author, title, dimensions, techniques and materials, provenance and date), the Museum it comes from, and must bear the phrase “by courtesy of the Fondazine Torino Musei”, as well as explicit notice of the ban on further reproduction or duplication by any means whatsoever.

The Museum owning the object must be cited as follows:

______

The photographic credit will be the following:

______

Fee of Concession due:______

Eventual reimbursement of costs______

Number of copies of the publication due______

For the Fondazione Torino Musei______

( Dott. Riccardo Passoni, DIRECTOR of the PHOTOGRAPHIC ARCHIVE)

Place and date______________

The applicant must sign a copy of this form, together with the “Regulations for the reproduction of assets of the historical, artistic, archaeological and architectural heritage of the Museums appointed to the Fondazione Torino Musei”, and send the original to the Photographic Archive of the Fondazione Torino Musei, Via Magenta 31, 10128 Turin. A copy of the request form will be sent to the applicant with the approval of the DIRECTOR OF THE PHOTOGRAPHIC ARCHIVE and will include indication of the fee of concession due and the correct credits to be reported.