Model Release Form

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Model Release Form
Model’s Name: ______________________________________________
Model’s Address: ____________________________________________
Affix model photo here
___________________________________________________________
Models’s Phone: _____________________________________________
Model’s E-mail: ______________________________________________
Model’s Permission and Rights Granted
For good and valuable Consideration herein acknowledged as received, and by signing this release I hereby give the
Photographer/Filmmaker and Assigns my permission to license the Images and to use the Images in any Media for any
purpose (except pornographic or defamatory) which may include, among others, advertising, promotion, marketing and
packaging for any product or service. I agree that the Images may be combined with other images, text and graphics,
and cropped, altered or modified. I acknowledge and agree that I have consented to the publication of my ethnicity(ies)
as indicated here, but understand that other ethnicities may be associated with images of me by the
photographer/Filmmaker and / or Assigns for descriptive purposes.
I agree that I have no rights to the Images, and all rights to the Images belong to the Photographer/Filmmaker and
Assigns. I acknowledge and agree that I have no further right to additional consideration or accounting, and that I will
make no further claim for any reason to Photographer / Filmmaker and/or Assigns. I acknowledge and agree that this
release is binding upon my heirs and assigns. I agree that this release is irrevocable, worldwide and perpetual, and will
be governed by the laws of India.
I hereby declare and warrant that I am above 18 years of age in the legal jurisdiction applicable to this agreement. I
consent to the inclusion of this Model Release form including the personal details recommended in it being added to the
public database owned or operated by Mash Audio Visuals Pvt. Ltd. or its subsidiary.
To be completed by the model
To be completed by the Photographer
Date …………………...................................................
Photographer’s Name .......................…............
Model’s Signature .......................................................
Shoot Date .............................................….......
Model’s Printed Name ................................................
Photographer’s Signature........................…......
Model’s Date of Birth ..................................................
Shoot Description .............................................
Or, to be completed by the model’s parent or legal
..........................................................................
guardian (for minors):
……………………………………………………...
Date ...........................................................................
Delete as applicable......……*Parent / Legal Guardian
Definitions
“Assigns” means a person or any company to whom Mash Audio
Parent’s Name ............................................................
Visuals Pvt. Ltd. has assigned or licensed rights under this release as
well as the licensees of any such person or company.
“Consideration” means something of value I have received in
Signature ....................................................................
exchange for the rights granted by me in this release.
“Images” means all photographs taken as part of the Shoot.
Model’s Date of Birth ..................................................
“Media” means all media including digital, electronic, print,
television, film and other media now known or to be invented.
*Parent warrants and represents that Parent is the legal guardian
“Model” means me and includes my appearance, likeness and
of the Model, and has the full legal capacity to consent to the
form.
“Shoot” means the photographic or film session described in
Shoot and to execute this release OF ALL RIGHTS IN MODEL’S
this form.
IMAGES.
Witnesses (NOTE: All persons signing and witnessing must be of legal age. A person cannot witness their own
release.)
Name: _________________________________
Date: __________________________________
Signature:_______________________________
Head Office: 101-107, Vardhman Plaza, Plot No. 10, K.P. Block, Pitam Pura, Delhi-110088. Phone: +91-11-42686869, Fax: +91-11-27311070

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