Address (block letters) ……………………………………………………………………………….

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I hereby apply for permission to borrow the colour transparencies listed below in the following publication:

Author ………………………………………… Date of publication & price …………………

Title ………………………………………………………………………………………………

Other use Please give details (eg. Book jacket, poster, film, CD-ROM)

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B world rights, one language: please specify …………………………………………………….

C world rights, all languages

I understand that permission may be withdrawn at any time if any part of these conditions is infringed and that I shall be liable to indemnify the Library for any loss which it suffers because of such infringement.

1. I acknowledge that it is my responsibility to obtain any necessary consent to reproduce the photographs supplied by the Library from the owner of any copyright in the materials photographed, as according to the Reprographics Service Conditions.
2. I undertake to include in the publication an acknowledgment of the Library, naming it as ‘Lambeth Palace Library’ and giving the shelfmark/reference number of the work(s) with page or folio number(s).
3. The Library in all instances retains the copyright and Publication Right in photographs taken by its authorised agents.
4. I will not use the materials supplied by the Library for any purpose other than that specified above.
5. I will pay the appropriate reproduction fees in addition to the Library’s loan fees in accordance with the current price; I understand that loan fees are payable on acceptance of my order, and that an invoice will be sent to me.

NAME of the applicant: ……………………………….

*SIGNATURE: …………………………………………..

DATE: …………………………