EMG MODELS ACCOUNTING DISCLOSURE The following is a breakdown of some in-house services that will be charged back to your EMG model account and their respective costs. Please sign to acknowledge that you have agree and understand these terms and conditions. COMP CARDS: $175.00 FOR 50 CARDS WEBSITE (includes CDS calendar): $250.00 for every 6 months CDS Calendar (without website): $30.00/month POLAROIDS: $125.00 150.00 NON SCHEDULED PAYMENT ACH: $10.00 SHIPPING AND HANDING: FEDEX, UPS, MESSENGER: at cost per receipt OPTIONAL SERVISES PUBLICATION IN MAGAZINES, PHOTO SHOOTS: at costs per approved invoice RUNWAY CLASS, RUNWAY COACH 1-ON-1: at costs INSTAGRAM REVIEW, INSTAGRAM COACHING: at cost, based on needs ADDITIONAL CLASSES AND COACHING: at cost, based on needs Accepted and Agreed, Print name below: Your signature below: If you are under 18 years of age, accepted and agreed, Print name, relationship of parent or legal guardian: Parent or legal guardian signature below: VACCINATION STATUS 2 DOSES: YES DATE 1ST DOSE: NO BOOSTER: YES DATE 2ND DOSE: BOOSTER DATE: Model information Date of birth Model name legal name Nationality Place of birth Social security # Green card # Home address city State / province / region Zip / postal code country Home telephone # ( with area code ) Mobile telephone # ( with area code ) email Fax telephone # ( with area code ) LANGUAGES SPOKEN FLUENTLY NO EMERGENCY CONTACT PERSON INFORMATION Model’s nyc information EMERGENCY CONTACT PERSON Model nyc address NAME City EMERGENCY CONTACT ADDRESS State & zip code Nyc telephone # ( with area code ) RELATIONSHIP MODEL/TALENT Nyc mobile # TO ( with area code ) Parent / guardian information Name of parent / guardian ( mother ) Name of parent / guardian ( father ) Parent / guardian Home address ( if different than above ) city State / province / region Zip / postal code country Parent / guardian Home telephone # ( w area code ) Parent / guardian Fax telephone # ( w area code ) Parent / guardian Mobile telephone # ( mother ) Parent / guardian Mobile telephone # ( father ) Parent / guardian email ( mother ) Parent / guardian email ( father ) Mother agency Name / agency Exclusivity? yes Contact person address city State / province / region Zip / postal code country office # ( with area code ) Mobile telephone # ( with area code ) email Fax telephone # ( with areaWHEN codeIT ) EXPIRES DATE OF YOUR CONTRACT/DATE Other agencies – please list all agencies worldwide Paris Milan London Brazil Canada Miami Los angeles Chicago Munich Hamburg Greece Amsterdam Madrid Barcelona israel ARE YOU SAG/AFTRA? YES NO / no passport information – please list all valid passports ( use back of sheet if more space is needed ) Passport # country Passport # country Passport # country Passport # country Expiration date Expiration date Expiration date Expiration date visa information Name of visa H1b B1 B2 O1 schengen Work permits Please select yes / no yes / no yes / no yes / no yes / no – please list all valid work permits Expiration date ( use back of sheet if more space is needed ) country Expiration date country Expiration date country Expiration date country Expiration date Model STATS Height Bust ( inches ) Cup size Waist ( inches ) Hips ( inches ) Dress ( US SIZE ) Shoe ( US size ) Eye color Hair color INSEAM PHYSICAL characteristics Please mark which are your best characteristics No Ears Teeth Skin Feet Legs hands Yes / no Yes / no Yes / no Yes / no Yes / no Yes / no / Left only / right only / both Body parts pierced? yes / no - if yes, please specify area(s) yes / no - if yes, please specify area(s) tattoos yes / no - if yes, please specify area(s) Smoker? Drink alcohol? Vegetarian / vegan Yes / no Yes / no glasses Contact lenses Clean driving record? Yes / no Yes / no Yes / no Yes / no Any major allergies / illnesses / conditions - if yes, please specify ( for example, Asthma, diabetes, etc ) Yes / no - if yes, which Yes / no Talents / skills / experience If yes, please specify ( ie, ballet, jazz, etc) Do you have any dance experience? Yes / no Shows Swimming Yes / no Yes / no Parachuting Water skiing Yes / no Yes / no Surfing Windsurfing Yes / no Yes / no Skiing Yes Hand gliding / no Yes / diving Yes no Yes / Bike riding / no Yes / Aqua lunging no / no Yes / no Yes / no Yes / no motor biking no Horse riding Yes / Gymnastics Yes Ice skating Yes Roller skating no Yes Yoga Yes / Semi-nude Fur Yes / no Yes / no Yes / no Lingerie Swimwear Cigarettes Yes / no Yes / no Yes / no Yes / no Yes / no Yes / no no Yes Do you have any acting experience? Yes / no Yes / no Yes / no Yes / no Yes / no MODELS.COM Yes / no Yes / no / no tennis would you consider? Nude / no Yes / no If yes, pleas MODELS.COM HANDLE / no Bank account information Bank name Routing # (FOR PAPER/ELECTPONIC) Account # ANY CHANGES TO YOUR BANK ACCOUNT INFO, EMAIL TO ACCOUNTING@EMGMODELS.COM YOU MUT RECEIVE THE EMAIL CONFIRMATION BACK MODEL/TALENT APPEARANCE PROTOCOL I hereby confirm that I will maintain my appearance (including measurements, skin, hair, facial hair, etc) as represented in my portfolio and only do any changes once consulted with EMG Models. If I change my appearance without prior consultation, I confirm that I notify the agency within 48 Hours from the changes but before any scheduled appointments, castings or bookings. I agree to re-shoot my digitals and portfolio if I change my appearance or my measurements have changed significantly. I understand that EMG Models cannot submit me to the clients nor schedule any go-see, castings, bookings etc. until I have updated my book accordingly. I agree to appear on time, properly groomed, dressed and styled in accordance with the client`s instructions for all appointments, shoots or other assignments. If my failure to do so results in any losses or expenses incurred by EMG Models, included any reimbursement to the client or commissions lost by EMG Models, I will bear responsibility for those losses and EMG Models has the right to recoup those losses from my future earnings. resident / non-resident Sign here date W-4 Employee’s Withholding Certificate Form (Rev. December 2020) Department of the Treasury Internal Revenue Service Step 1: Enter Personal Information OMB No. 1545-0074 Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Give Form W-4 to your employer. Your withholding is subject to review by the IRS. (a) First name and middle initial (b) Social security number Last name Address Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov. City or town, state, and ZIP code (c) 2021 Single or Married filing separately Married filing jointly or Qualifying widow(er) Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.) Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, when to use the estimator at www.irs.gov/W4App, and privacy. Step 2: Multiple Jobs or Spouse Works Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs. Do only one of the following. (a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or (b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or (c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld . . . . . TIP: To be accurate, submit a 2021 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator. Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.) Step 3: Claim Dependents If your total income will be $200,000 or less ($400,000 or less if married filing jointly): Multiply the number of qualifying children under age 17 by $2,000 $ Multiply the number of other dependents by $500 $ Add the amounts above and enter the total here Step 4 (optional): Other Adjustments Step 5: Sign Here . . . . . . . . . . . . . . . . 3 $ (a) Other income (not from jobs). If you want tax withheld for other income you expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income . . . . . . . . . . . . 4(a) $ (b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here . . . . . . . . . . . . . . . . . . . . . 4(b) $ (c) Extra withholding. Enter any additional tax you want withheld each pay period 4(c) $ . Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete. Employee’s signature (This form is not valid unless you sign it.) Employers Only . Employer’s name and address For Privacy Act and Paperwork Reduction Act Notice, see page 3. Date First date of employment Cat. No. 10220Q Employer identification number (EIN) Form W-4 (2021) Advertising Campaigns Client Name Date(MM/YY) Y) Agency That Booked 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Catalogue/Ecommerce/Lookbook/Social Media Client Name Date (MM/YY) Agency That Booked Type , Rate (Catalogue/ecom/lookbook/social) 1. 2. 3. 4. 5. 6. 7. 8 9. 10.
