Artist's consent to urther usage of his / her artworks acc to Polish law and license representation agreement (english, Poland)

                           city, country , date of statement, (напр.:31 December 2021)📆

STATEMENT - CONSENT

I, the undersigned ПІБ повністю (Eng.) , a visual artist, designer and a sole trader running a business under registered business name ПІБ повністю (Eng.) , under business number ІПН , located at Адреса реєстраціі місця проживання (прописки) (Eng.) , hereby consent, represent and warrant as follows:

1.       I consent and authorize Повне найменування (Eng.) , a company registered under the law of Країна реєстрації (Eng.) , company code Код компанії , with registered office at Адреса місцезнаходження (юридична адреса) (Eng.) , (hereinafter: “Скорочене найменування (Eng.) ”) to manage the Non-Exclusive License Agreement concluded between Повне найменування (Eng.) and Повне найменування (Eng.) , a company registered under the law of Країна реєстрації (Eng.) with registered office at Адреса місцезнаходження (юридична адреса) (Eng.) (hereinafter: "Скорочене найменування (Eng.) ") on date of license agreement, (напр.:1st of May 2021)📆 the copy of which is attached hereto (hereinafter: “Agreement”) and to use my artworks created for the purpose of the Agreement (hereinafter: "Artworks") as well as my name, my likeness and my registered business name by Повне найменування (Eng.) in relation to manufacturing, sale and marketing of licensed products in accordance with the Agreement; in particular, I agree to:

a)      reproduction, of any known technique, on any known media, including digital recording technique, of Artworks and of my name and registered business name, and for their reproduction, also in public;

b)      dissemination of Artworks  and materials containing my name and registered business name for the purpose of the Agreement; i.e. introducing (in whole, in parts, fragments) the original or copies (copies, including digital, electronic) on which materials with Artworks, my name and registered business name have been recorded - marketing, lending or renting the original or copies, including for use in marketing materials, also as an element of collective works, public exhibition, display, as well as public sharing in such a way that everyone can have access to it in a place and time chosen by them; the consent granted for the dissemination of the materials and their derivative works applies to all known media distribution channels, including the Internet;

2.      I will not exercise my moral rights related to Artworks and to the use of my name and registered business name in relation to Artworks against Скорочене найменування (Eng.) , its successors, assignees, distributors or associated companies, and will not enforce those rights against Скорочене найменування (Eng.) , its successors, assignees, distributors or associated companies;

3.      The amounts to be paid by Повне найменування (Eng.) to ПІБ повністю (Eng.) according to the Agreement constitute entire and fair benefit and remuneration for the creation of the Artworks, granting the license and authorizations with regard to the Artworks, their use and the use of my name and registered business name by Скорочене найменування (Eng.) in the entire scope set forth in the Agreement (especially for all exploitation fields mentioned in the Agreement) and constitute a fair compensation for any profits obtained by Скорочене найменування (Eng.)   as a result of using the Artworks and my name and registered business name. I will not pursue against Скорочене найменування (Eng.) any other benefits or remuneration in connection with the Artworks, especially their use by Скорочене найменування (Eng.) , including the remuneration mentioned in the Article 22 of Polish Act of June 30, 2000 –  the Law on Industrial Property, and will not make any claims against Скорочене найменування (Eng.) related to the use of Artworks and my name and registered business name - business name will be solely responsible for paying to me any remuneration related directly or indirectly to the Agreement;

4.      I undertake not to exercise the right to withdraw any of the consents granted hereunder during the term of the Agreement and for a period of ninety (90) days following its expiration.

                    ........................................................................... ПІБ повністю (Eng.)

                                                                                                             (legible signature)