Permission Request Form

For a publication under the

To:

[Please enter here the name and address of the rights owner of the material mentioned below. Usually this is the publisher of your source publication, sometimes this is the originator. Please check the copyright notice of the source publication or the copyright given in the illustration or in the figure caption.]

I am preparing with the following bibliographic data:

International Conference on Intelligent Data Communication Technologies and Internet of Things (ICICI) 2018

to be published by

and I am requesting permission to use the material described below from your publication(s) as follows:

  1. Author(s)/Editor(s)/Originator(s) of the material:
  1. If the material was previously published, where was it first published:

Book title: Edition:

or
Journal title: Volume: Article title:

or
Online/database publication:

Year of publication:

Page(s):

Publisher/rights holder:

  1. Material to be used in the planned publication: [please enter here a short description of the material or refer to an appendix added to this form listing the material]

We will ensure that full acknowledgment will be given to your publication.

Would you kindly grant permission for our original publication, as well as for all revisionsor versions, future editions, in any medium, such as in its electronic form (offline, online), for all translations in any foreign language,and for distribution throughout the world. Wewould like to ask you to sign below and return the form to the address given below:

Thank you very much for your kind assistance.

Date: Requested by:

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Permission granted:

Date: