Affidavit Of Eligibility And Liability printable pdf download

Affidavit of Eligibility and Liability/Publicity Release

STATE OF California

COUNTY OF Los Angeles

I, _________, being duly sworn, say that I am of legal age in my home territory or older and my social security

number is

. I reside at___________. My daytime telephone number

is________, and my evening telephone number is (

)

I am submitting this Affidavit of Eligibility and Liability/Publicity Release (“Affidavit/Release”) to Sony Pictures

Digital Inc. ("SPD"), with the understanding that it will be relied upon by SPD in connection with my having been

awarded, subject to eligibility, the Grand Prize in the _________________Contest (the “Contest”), as such Prize

is described in the Contest's Official Rules (attached hereto).

I hereby represent and affirm that I have read, have complied with, and will continue to comply with

all the rules, regulations, terms and conditions set forth in the Official Rules; that all of the

information I have provided and will provide to the SPD has been and will be true, accurate, and

complete; that I have not perpetrated and will not perpetrate any fraud or deception in connection

with the Contest; and that I have not sought to influence the outcome of the Contest other than by

participating in the Contest as expressly permitted in the Official Rules. I further represent that I am

neither an employee or agent of any of the SPD nor the immediate family member (spouse, mother,

father, sister, brother, daughter, or son) or member of the same household (whether related or not)

of any such employee or agent, and that I have not participated in the Contest on behalf of any such

employee or agent.

I understand that SPD or their agents may be required to advise the United States Internal Revenue

Service of the value of the Prize awarded to me in the form of a Form 1099, and, in connection

therewith, I have attached to this Affidavit a completed Form W-9 concerning the Prize.

I, ON BEHALF OF MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, AND ANY

OTHER PERSON(S) WHO MAY TAKE BY OR THROUGH ME, HEREBY RELEASE, FOREVER

DISCHARGE AND AGREE TO HOLD HARMLESS THE SPD AND ALL OF THEIR RESPECTIVE

PARENT COMPANIES, SUBSIDIARIES, AFFILIATES, ADVERTISING AND PROMOTIONAL

AGENCIES, AND EACH OF THEIR OFFICERS, DIRECTORS, EMPLOYEES, AGENTS,

SHAREHOLDERS, AND ADVISORS (COLLECTIVELY, “RELEASED PARTIES”), FROM AND

AGAINST ANY LIABILITY FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES AND LIABILITIES

OF ANY NATURE WHATSOEVER WHICH I MAY NOW OR HEREAFTER BE ENTITLED TO

ASSERT, INCLUDING BUT NOT LIMITED TO ANY DEATH, INJURY, LOSS OF ENJOYMENT,

PROPERTY DAMAGE, OR OTHER HARM OR LOSS OF ANY NATURE, ANY CLAIMS BASED ON

PUBLICITY RIGHTS, PRIVACY RIGHTS, PERSONALITY RIGHTS, “MORAL RIGHTS,” OR

DEFAMATION, AND ANY AND ALL ANY TAXES LEVIED, ASSESSED OR COLLECTED,

WHETHER CAUSED BY, CONTRIBUTED TO, ARISING OUT OF, OR OTHERWISE RELATED TO

THE CONTEST, THE PRIZE, OR MY POSSESSION, ACCEPTANCE, USE, OR MISUSE

THEREOF, OR MY OTHER ACTS OR OMISSIONS IN CONNECTION THEREWITH.

Affidavit Of Eligibility And Liability