Request of Authorization to Carry Out Filming

To send via e-mail:

This authorisation is requested by:

Person concerned or legal representation of the person concern

………………………………………………………………………………………………………

Date of birth………………….……….Residing in/address ……………………………………

Tel.…………………. Fiscal Code………………. . .. Fiscal Domicile ……………….……….

Legal representative of the company……………………………………………………………

Legal Office………………………………………………......

Tel.……………………...... E-mail……..…………………………………..…..………………… ..

VAT number……………………………………… Intracommunity VAT number………………

To make the film in the ways of, for the purpose of, and with the means indicated below::

Location ……………………………………………………………………………………………..

Period from …………………………… to ………………………………

For the depiction of:

Film □ fiction □ documentary □ short film □ TV service □ advertising □

video clip □

Title/Name of production

………………………………………………………………………………………..

Insurance coverage……………………………………………………………

Attach confirmation of the full payment at the time of shooting;

Attach Story-board; sceneries? Yes □ No □;

a. Technical equipment, attach : - detailed list of equipment, their characteristics and power inWATT

- List of components of the shooting group

The facility reserves the rights to choose the ways and times compatible with our need to ensure fullaccessibility of the museum spaces to visitors from the public, and to ensure the safety of decorations andintegrity of the environments and the historical-artistic heritage preserved therein.

The technical staff of the Museums determines the fees due for the granting of rights for reproduction anduse of historical heritage in the state of Florence. (Left out code by accident)

- Free of charge for reproductions made for reasons of personal use or justified reasons for study.

- All other cases are subject to fees that are to be decided by the technical staff of the Museums.

The authorization for occasions associated with promoting of cultural good are subjected to a daily fee ofeuro 1.874,74.

The fee above includes reproduction rights in addition to:

- One (1) language,

- One (1) showing in one (1) television network.

- Subsequent showings on the same television network cost a fee increase of 25% for a secondshowing, and a 75% increase in the case of more than two showings on the same network.

- For showings on different networks the fees must be again paid in its entirety for each network.

-World rights correspond to triple the rate indicated.

This applicant is committed to deliver to the facility a lawful copy of the audiovisual production that iscreated.

Case (mandatory):

A fee is added to the cost of the production staff (at the expense of the applicant).

The number of required units is to be decided by Museum Staff on the characteristics of the number ofshots that need to be taken and the number of people the comprise the group.

Sign and Date after you are fully satisfied with the standard requirements stated above

Date and Place Signature

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