CARLOS PALANCA MEMORIAL AWARDS FOR LITERATURE 2013 c/o CPMA Research Facility 6F Unit 603 Park Trade

Center 1716 Investment Drive, Madrigal Business Park, Ayala Alabang, Muntinlupa City 1770

AUTHORIZATION
I am hereby entering the enclosed work(s) listed below in the Carlos Palanca Memorial Awards for Literature contest (the Palanca Awards) for the year 2013. I represent and warrant that I have written or created the said work(s) and that I am the absolute owner of the copyright(s) and other intellectual property rights pertaining to the said work(s). TITLE 1. ______________________________________________ 2. ______________________________________________ 3. ______________________________________________ 4. ______________________________________________ 5. ______________________________________________ DIVISION ________________________ ________________________ ________________________ ________________________ ________________________ CATEGORY ________________________ ________________________ ________________________ ________________________ ________________________

I declare that I have read the rules of the contest (the Rules), and hereby accept the said Rules and the right of the Carlos Palanca Foundation (the Sponsor) to the first and all subsequent publications, presentations, video and/or live streaming, and/or dissemination, of all winning entries as provided therein, in print, electronic, and/or any other manner or form, including through the Internet. Pursuant to R.A. No. 8293, and in order to give public access to the winning works, I grant, assign, and transfer unto the Sponsor or its assignees, the right, without necessity of any payment other than the prize which may have been awarded: to publish from time to time any winning entry or selection or portion thereof as it may at its discretion determine; to designate or appoint editors to edit the work or any portion thereof to suit the demands of publication; to furnish a reasonable number of copies of all winning works to the National Library or other libraries; to make the works available for downloading on the Internet or other electronic media; and to allow students to make copies for research or in connection with their school requirements. In the event that a prize is awarded to me in the One-act Play, Full-length Play, and Dulang Pampelikula categories, I also grant, assign, and transfer to the Sponsor the right to produce, or authorize the production of, and/or carry out the staging, telecasting, broadcasting, cinema, or other forms of exhibition whether over the Internet, through other electronic media, or on location, from time to time, any winning entry of mine, or selection or portion thereof as it may in its discretion determine. The Sponsor shall also have the right to appoint or designate editors or directors who may edit the work or any portion thereof to suit the demands of production or exhibition. The prize money which may be awarded to me for any of the enclosed work/s shall constitute full payment of the foregoing rights assigned to the Sponsor, and shall be in lieu of any royalties or other compensation to me. Furthermore, I hereby confirm and re-affirm the assignment of the intellectual property rights stated in the preceding paragraph, in favor of the Sponsor, with respect to all of my previous Palanca Award prize winning work/s without necessity of any payment other than the prize/s already awarded.

Authors Printed Name

Authors Signature

(NOTE: If the participant is a minor, the following should be accomplished by the parent or legal guardian.) PARENTAL CONSENT (For contestants who are minors.) I, the undersigned parent and/or legal guardian of _______________________________________, hereby execute this Authorization Form on his/her behalf. _________________________________ Printed Name and Signature (Parent/Legal Guardian)

ACKNOWLEDGMENT Republic of the Philippines) ) S.S. BEFORE ME, this ____ day of _____________________, in ____________________, Philippines, personally appeared: Name Competent Evidence of Identity Date/Place of Issue/Validity Period

known to me and to me known to be the same person/s who executed the foregoing instrument and who acknowledged to me that the same is his/her/their voluntary and free act and deed. Doc. No. ____; Page No. ____; Book No. ____; Series of 2013.