SAG-AFTRA RESIDUALS CHECK AUTHORIZATION FORM (MINORS) You are hereby authorized and directed to send Artist’s residual checks for the production or markets listed below to the following franchised talent agent: Agency Name: _______________________________________ Agency ID #: _______________________________________ _________________________________ DATE ___________________________________________ SIGNATURE OF PARENT/GUARDIAN _________________________________ SOCIAL SECURITY NUMBER ___________________________________________ ARTIST'S NAME (Printed or Typed) _________________________________ LOAN OUT COMPANY NAME ___________________________________________ FEDERAL ID# ENCLOSE COPY OF BIRTH CERTIFICATE, COURT ORDER, OR OTHER EVIDENCE THAT THE PERSON EXECUTING THIS FORM IS THE PARENT/GUARDIAN OF ARTIST. In lieu of such evidence, a duly authorized representative of the Agency must execute the following: The undersigned Agency hereby agrees to defend, indemnify, and hold Screen Actors Guild-American Federation of Television and Radio Artists harmless from any and all claims, injuries, damages, losses or suits including attorney fees, arising out of or in connection with compliance with this residuals check authorization. _________________________________ ________________________________ Signature of Representative Agency Name Initial below: Complete either Section A or Section B. If both are selected, SAG-AFTRA will default to Section B. __________________________________________________________________________________________________ SECTION A: All Commissionable Residuals Check Authorization NETWORK PRIMETIME/ Exhibit A/ CW (All Commissionable Checks) NON-NETWORK (SYNDICATION)/ NON-PRIMETIME FREE TV (All Commissionable Checks) For Section A Only: This Authorization SUPERSEDES ANY PRIOR DATED AUTHORIZATION that SAG-AFTRA may have on file for me with this agency or any other agency. ______________________________________________________________________________________________________ SECTION B: Episodic Check Authorization Only (Network Primetime/ Exhibit A/ CW, Non-Network (Syndication)/ Non-Primetime Free TV) Production Company: ____________________________________________________ Production Series/Title: _________________________________________________ Production Episode # and Title: ____________________________________________ Please deliver to either office: Los Angeles SAG-AFTRA: Professional Representatives Dept., 5757 Wilshire Bl., 7th Fl., Los Angeles, CA 90036 New York SAG-AFTRA: Professional Representatives Dept., 1900 Broadway, 5th Floor, New York, NY 10023 This authorization will remain in effect until WRITTEN notice of revocation is made by actor or his/her parent or guardian. I hereby agree to indemnify and hold SAG-AFTRA harmless of and from any and all loss, cost or expense which may be incurred or suffered by SAG-AFTRA, by reason of any action taken by SAG-AFTRA, in reliance upon this authorization. SAG-AFTRA will accept ORIGINAL signatures only, no photocopies. This authorization covers all work within SAG-AFTRA’s jurisdiction. Please retain copies for your records.
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