Copyright Declaration Form
* On receipt at OCR, please pass a copy of this form to the Copyright Team *
A copy of this form MUST be completed by the Setter for each question paper submitted to OCR.
A completed form should accompany the FIRST and FINAL drafts of the paper.
Failure to submit a completed form may result in a delay to payment.
Please complete the details below:
Unit & Comp No.:
Tier:
Unit Title:
Subject:
Series:
Setter’s Name:
OCR is legally obliged to apply for permission to use extracts taken from any published material
(e.g. books, newspapers, and websites). Material published on the internet is subject to the same
copyright laws as printed sources, and therefore needs the same clearances as other materials.
Please try to avoid unattributed images from the internet, material from blogs, message boards or
uncorroborated information from open source directories, such as Wikipedia. Please DO NOT
apply to copyright holders directly on OCR’s behalf.
BEFORE SUBMITTING YOUR PAPER PLEASE CONSIDER CAREFULLY WHETHER THE
COPYRIGHT MATERIAL YOU HAVE USED IS ABSOLUTELY NECESSARY.
Where it has been used, please provide a copy of ALL materials and complete the next page
of the form giving as much detail as possible.
For adapted extracts:

please mark-up a copy of the original text clearly showing any changes made (a word count will be needed of both
the original and adapted version for copyright permissions)
For text from books, journals, magazines etc.:

Also include a photocopy of the imprints page (showing the copyright acknowledgements, ISBN/ ISSN number etc.)
For newspapers (text only):

Date of publication

Journalist’s name

Exact wording of headline [if full article not available]

Page no(s)
For text from websites:

Full webpage address of page from which material is taken, not just the home page address and provide a print-out
of the web page with the URL address as web pages often change.
For illustrations/ diagrams/ photographs/ charts/ graphs:

Name of illustrator/ photographer/ graphic designer/ image library etc. (this may appear with the image, with the
credits of the article or on the imprints page of a book)

If the image provided is indicative of what is required, and it could be redrawn by our own artists or an alternative,
similar image sourced please indicate this.
If the necessary information is not provided and the copyright holder cannot be traced, then
OCR will not be able to obtain the required copyright permissions, and we will not be able
to use the requested image.
OCR 2012
Copyright Declaration Form
1
PLEASE COMPLETE IN BLOCK CAPITALS. Please provide a copy of ALL materials used:
Question
Number
Unit & Comp No:
Brief description
of material
(e.g. adapted text,
photo, data for graph)
Setter’s Name:
Series:
Title and page
number of
publication
Author(s)
ISBN/
ISSN
No.
Date of
publication
(or date of
accessing
website)
Full website
address
(if
applicable)
Name and
address of
publisher
Name and
address of
copyright holder
Office
use
only:
LIBS
number
Insert any additional rows required in the table using [Table/Insert/Rows Below].
OCR 2012
Copyright Declaration Form
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Copyright Declaration:
Unit & Comp
No:
Setter’s Name:
Series:
Please tick whichever of the following two statements applies to this draft paper, and then sign and date this document .
I declare that this draft paper contains NO material that is the copyright of a third party. I further declare
that the questions in this paper have been prepared exclusively for this paper, and that I assign to OCR the
copyright of these questions.
I declare that I have provided a copy of, and listed on this form all the material in this draft that is the
copyright of a third party. I further declare that the questions in this paper have been prepared exclusively
for this paper, and that I assign to OCR the copyright of these questions.
Signed:
Date:

If you are returning your question paper electronically, please type your name and creditor
number into the signature box above and return an electronic copy of this form on the same media
as the question paper.
OCR 2012
Copyright Declaration Form
3