Dear Sir/Madam
I am writing to request permission to use material previously published by you as detailed on
the attachment. Please complete and return to myself at the address detailed above.
Yours faithfully
COPYRIGHT CLEARANCE FORM FOR USE BY AUTHOR
(To be submitted to the copyright holder in duplicate)
Dear Sir/Madam
(Authors here)
(Title here)
(Title of where to be published and publisher)
I am preparing a manuscript and I would be grateful for your permission to include the
material specified below (copies are attached if appropriate)
Nonexclusive world right in the English language are requested for the use of the material in
the above work printed and/or electronic form and in any future editions or subsets thereof;
appropriate acknowledgement will be made. I would greatly appreciate your granting this
permission by completing and signing the release form below, returning to me one copy of
this letter and retaining the other copy for your files.
Yours faithfully
I/we hereby grant permission for the use of the material requested above.
Signed: ......................................................................... Date: .......................................................
Copyright Holder: ........................................................................................................................
Publisher .......................................................................................................................................