Power of Attorney D (W)

Ivana Broza 8a, 10000 ZAGREB

tel.: +385 1 3033 600 fax.: +385 1 3033 630

POWER OF ATTORNEY – D (W)

FOR FOREIGN CITIZENS

I, (name)______(parents name)______(surname) ______

______

(residence address – street, city, postal code, country)

______

(mailing address, if different from residence address – street, city, postal code, country)

with my signature below hereby grant power of attorney to the CROATIAN PERFORMERS’ RIGHTS COLLECTING SOCIETY (hereinafter: HUZIP) of Zagreb, I. Broza 8a, to collectively exercise and protect my rights as a performing artist in accordance with the valid approval of the State Intellectual Property Office of the Republic of Croatia and pursuant to the valid legislation of the Republic of Croatia, and multilateral treaties and conventions that bind the Republic of Croatia.

I herewith authorise HUZIP in its name but for my account, to:

1.  issue licences for broadcasting and re-broadcasting, communicating to the public and other use of fixed performances, including making available to the public and rental of fixed performances in which I participate as a performing artist;

2.  dictate, negotiate and collect fees for broadcasting and re-broadcasting, communicating to the public and other use of fixed performances, including making available to the public and rental of fixed performances, and fees for public lending and reproduction for private and other personal use of fixed performances in which I participate as a performing artist, and to distribute collected fees in compliance with the by-laws of HUZIP;

3.  conduct special monitoring and control of use of fixed performances for the purposes of exercising my rights as a performing artist;

4.  render legal and other assistance for the purposes of protection of my rights as a performing artist;

5.  conduct all other legally-permissible and mandatory activities pertaining to exercising and protection of my rights as a performing artist, and particularly to launch court, administrative and other proceedings aimed at the protection of the rights specified in this power-of-attorney.

______(signature)

I hereby also authorise HUZIP to exercise my individual rights in its name but for my account, as follows:

- to issue licences, negotiate rates and collect fees for reproduction of fixed performances in which I participate as a performing artist by storage (by compression or otherwise) in the memory of any device or any media whatsoever and distribution of such fixed performances in any form whatsoever (except that form customary for phonographic distribution) and to distribute fees collected in compliance with the by-laws of HUZIP.

______(signature)

This power of attorney may be revoked in writing at any time.

HUZIP shall pay the grantor of this power of attorney the fee amounts he/she is entitled to on the basis of his/her performing rights in compliance with legal regulations and the by-laws of HUZIP.

PAYMENT DATA:

Bank (name, address and SWIFT/BIC)______

______

IBAN /account number______

PERFORMING ARTIST'S PERSONAL DATA

Name ______Surname ______Artistic name ______

Maiden surname ______Sex (encircle): M F

Date of birth City ______Country ______

Country of residence ______Nationality______

OIB (Personal indetification number) assigned by Croatian Tax Office

IPN (if accorded)

Ph.______Fax.______

Cell. ______E-mail ______

Type of performer: singer instrumentalist conductor

(Encircle)

FOR INSTRUMENTALISTS:

List all instruments you play in recordings:

______

______

Member of orchestra/group (specify date of joining): ______

______

Previous engagements in orchestra/group:

______from ______to ______

______from ______to ______

______from ______to ______

I DECLARE UNDER FULL MATERIAL AND PENAL ACCOUNTABILITY THAT THE ABOVE DATA ARE TRUE AND ACCURATE.

I HEREBY DECLARE THAT I HAVE READ, UNDERSTOOD AND ACCEPT HUZIP'S PRIVACY POLICY. FURTHERMORE, I HEREBY DECLARE THAT I HAVE BEEN INFORMED OF THE FACT THAT HUZIP WILL PROCESS MY DATA STRICTLY FOR THE PURPOSE OF COMPLIANCE WITH HUZIP'S LEGAL OBLIGATIONS ARISING FROM THIS POWER OF ATTORNEY, AS WELL AS INTERNATIONAL AND DOMESTIC LAWS, SUCH AS THE CROATIAN COPYRIGHT AND RELATED RIGHTS ACT, BILATERAL AND MULTILATERAL AGREEMENTS AND INTERNATIONAL CONVENTIONS AND THE GENERAL DATA PROTECTION REGULATION.

Place and date ______

(signature)