* First Name (required)

* Last Name (required)

* Your Email (required)

Name of the intellectual property (IP) owner (if not you):

* Country of Submitter (required)

* Please describe your intellectual property (IP) in detail (required) :

• Copyright: identify the type of work (e.g., text, video, image, code, audio) and provide a description sufficient to recognize it when viewed.

• Trademark: identify the type of trademark (i.e., word or phrase, logo, word and design), country where registered, registration number, and provide a description of the alleged infringement.

The location (specific URL link) where we can view your work, if available:

* Specific location (URL) where your intellectual property (IP) is being infringed (list multiple URLs on separate lines by hitting 'enter' after each URL) (required)

• NOTE: Provide page specific URL where your IP is infringed (e.g., https://www.stageclip.com/specificpage

Additional information that would help us identify your work and understand the basis of your claim of infringement:

Required Statements

Good Faith Belief
By typing in my name (electronic signature), I have a good faith belief that the use of the material is not authorized by the intellectual property owner, its agent, or the law (e.g., it is not fair use).

Authority to Act
I represent that the information in the notification is accurate, and under penalty of perjury, that I am authorized to act on behalf of the owner of an exclusive right that is allegedly infringed.

512(f) Acknowledgement
As applicable under 17 U.S.C 512(f), I acknowledge that I may be subject to liability for damages if I knowingly materially misrepresent that material or activity is infringing.

I understand that the information submitted in this form may be shared with third parties, including the alleged infringer about whom I am filing this complaint.

Signature

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