Copyright Declaration Form - Lancashire County Council

LANCASHIRE ARCHIVES
Copyright Declaration
Form
Enquiry number
For office use only
Please supply me with a copy of the items listed, required by me for the
purposes of research or private study.
I declare that, where this material is in copyright:
(a) I require the copy for purposes of research for a non-commercial purpose or
private study only and will not use it for any other purpose
(b) I have not previously been supplied with a copy of the same material
(c) I will not supply a copy of it to another person nor publish it on any website
(d) (for unpublished works only) to the best of my knowledge, no work listed has
been published at any time before the records were deposited with Lancashire
Archives nor has the copyright owner prohibited copying
(e) (for published works only) to the best of my knowledge, no other person with
whom I work or study has made or intends to make, at or about the same time
as this request, a request for substantially the same material for substantially
the same purpose
I understand that if this declaration is false in any material particular the copy
supplied to me by you will be an infringing copy and that I shall be liable for
infringement of copyright as if I had made the copy myself.
I also understand that I shall become Data Controller responsible for compliance
with the Data Protection Act 1998 in relation to any processing of personal data
(information, facts or opinions, relating to an identifiable living person) obtained
from copies supplied.
TITLE………………….
NAME …………………………………………………….…
HOME ADDRESS………………………………………………………………………….
………………………………………….
POSTCODE …………………..………..
DAYTIME PHONE NO: ……………………………….
Email: …………………………………… (We will only use this email address to contact you about
your order or enquiry. We will not use this address for any other purpose).
Signature …………………………………….
Date ……………………………..
Under the Data Protection Act 1998, Lancashire County Council is the Data Controller for this form. LCC’s representative
is the Data Protection Officer. The data is required to ensure no infringement of the Copyright, Designs and Patents Act
1998, statutory modification or re-enactment thereof, or the Data Protection Act 1998, is made in supplying copies from
Lancashire Archives, and to enable the production and distribution of reprographic orders.
Jan 2011