CARLOS PALANCA MEMORIAL AWARDS FOR LITERATURE

OFFICIAL ENTRY FORM AND GRANT/ASSIGNMENT OF RIGHTS

(This form must be notarized.)

Entry No.
(to be accomplished by

CPF staff

Year: 2015

AUTHORS NAME

Date of Birth (DD/MM/Year)

Place of Birth

Age

Gender
F

Civil Status

CONTACT INFORMATION
HOME
ADDRESS
LANDLINE
MOBILE NO.
FAX NO.
EMAIL

WORK/BUSINESS

:
:
:
:
:

For first-time participants, please indicate how you learned of the Palanca Awards:

AUTHORIZATION
I am hereby entering the enclosed work(s) (the Work(s)) listed below in the Carlos Palanca Memorial Awards for Literature contest (the Palanca Awards) for the current
contest year. 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

DIVISION

CATEGORY

PUBLISHED/PRODUCED WORKS
Indicate publication, publisher, and publication date/
venue of production, producer, and production date

1.
2.
3.
4.
5.
In the event that any entry of mine is awarded a prize, I authorize the Sponsor to post the winning Work(s) in its/their entirety on the
CPMA Website to enable the public to download it for free.

YES

NO

I declare that I have read the rules of the contest (the Rules), and hereby accept the said Rules. I hereby grant and assign to the Carlos Palanca Foundation,
Inc., (the Sponsor) the concurrent and non-exclusive right to exercise the copyright and other intellectual property rights granted to the author and the authors
assignees, with respect to any winning work (the Work). This grant and assignment also extends to all forms of storage, transmission, dissemination, and communication
presently existing or subsequently created. The prize money which may be awarded to me for any of the Work 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.
To promote Philippine Literature in the modern world of information technology, the Sponsor intends to make the winning entries accessible through the
internet or other electronic media, to serve as a literary archive of the contest. The website or other media to be established for this purpose are intended to be a
repository of the award-winning Works, recording the history of the development of Philippine literature over the years through the Palanca Awards. In making the
Work(s) thus available to the public, the Sponsor intends purely to promote literary appreciation for and public awareness of such Work(s), and not to commercially exploit
the same. I have indicated on this form my preference whether to have my Work(s) posted on the CPMA website and made available for downloading by the public for
free in the event that a prize is awarded for the Work(s). To encourage use for educational purposes, winning Work(s) shall be posted on the website in their entirety. I
understand that should I subsequently instruct the Sponsor in writing to include or remove the Work(s) from the Internet archive, such instruction will be honored and the
Work shall be included or removed from the Internet archive within a reasonable time from Sponsors receipt of my written instruction. I acknowledge and agree that the
exclusion of any winning Work or Works from the website shall not constitute a waiver of any of the Sponsors Rights.

Authors Signature

Authors Printed Name

(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 document 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

Government-issued 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 201_.