Request form for use of images of works owned by the Musei Civici di Monza

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The undersigned*

resident in*

POSTCODE*

Province*

State*

in street/square*

Telephone

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Email*

As (please indicate whether the request is made in a private capacity or as the legal representative of an association, scholar, researcher, author, etc.)st is made in a private capacity or as legal representative of an association, scholar, researcher, author, etc.)*

REQUESTS

The authorisation to use the image(s) listed below for the following purpose (please cross out the request):

Free concession for:

study or research purposes without publication of the image on behalf of (e.g. university, museum, research institute, cultural association...)

publications, editorial productions, magazines and periodical publications of a scientific non-profit nature by museums, universities, research institutes and cultural associations

non-profit publications or materials or initiatives with an educational or scholastic purpose

Indicate study reasons, title, print run number and number of copies

Onerous concession for:

publications, publishing works such as art books, exhibition catalogues or similar, cultural events and any other type not falling under the above categories intended for marketing

for-profit publications or materials or initiatives with an educational or scholastic purpose

promotional uses (specify)

other (specify)

Specify promotional or other uses:

Method of payment

(fill in only in case of onerous concession)

If the issuance of PagoPA payment notification / e-invoice is required, please indicate the complete data for the issuance of the accounting document.

Accounting receipt with PagoPA bulletin (payment method indicated in the notice itself)

Electronic invoice

Holder: (company name)

Street/Square, number

City

Postal code

Province

State

Email holder

Tax ID code / VAT number

PEC

UNIVOCO CODE OFFICE (for public subjects)

Image(s) requested

Terms and conditions for the use of images owned by Musei Civici di Monza

The Musei Civici di Monza, in compliance with the provisions of Municipal Council resolution no. 305/2018, grant the use of images reproducing works belonging to the civic collections under the following conditions:
General conditions - the image, supplied in electronic format, may be resized but not manipulated, altered or modified in any way - the image may be used only for the purpose/publication for which the request is made - any reproduction of the image must always be accompanied by the wording ‘© Musei Civici Monza’ - the use of the image does not entail the assignment of any rights; all legal rights are reserved to the Municipality of Monza - Musei Civici - the image shall not be transferred to third parties, nor used for any reproduction by computer or any other means - for any other or subsequent use of the image, specific authorisation must be requested in advance. Fees free-of-charge concession - study or research purposes at museums, universities, research institutes and cultural associations without publication of the image - publications, editorial creations, magazines and periodical publications of a non-profit scientific nature carried out by museums, universities, research institutes and cultural associations; - publications or materials or non-profit initiatives with educational, scholastic or academic purposes. In the case of a free-of-charge concession for the purpose of publication, a copy shall be sent to the Ufficio Musei Civici - Via Teodolinda, 4 - 20900 Monza (MB). Onerous concessions € 65.00 + VAT 22% for each digital colour reproduction. For onerous concessions the Municipality will send a regular invoice for the total amount to the name and address indicated in the application. The requested image will be sent only after confirmation, by fax or email, that payment has been made. ategories: - publications, editorial productions such as art books, exhibition catalogues or similar, cultural events and any other type not falling under the above categories intended for commercialisation - publications or materials or initiatives for profit having an educational or scholastic purpose - promotional uses any use of the image that differs from what is declared and undersigned or unauthorised will be prosecuted pursuant to the laws in force.

Declaration of Acceptance of Terms and Conditions*

Declares for this purpose

- to have read the above "Terms and Conditions" applied by the Municipality of Monza in relation to the concession of use of the images and any fees due;
- to guarantee that the images granted will be used for the stated purpose only;
- to undertake to send, if the image is granted free of charge, a copy of the eventual publication to Musei Civici di Monza - Ufficio Musei Civici - Via Teodolinda, 4 20900 Monza.

Date of compilation*

DD slash MM slash YYYY

I have read and accept the privacy policy according to Regulation 679/2016/EU*

Please note that all personal data (common identification, sensitive and/or judicial) communicated to the Municipality of Monza will be processed exclusively for institutional purposes in compliance with the provisions of Regulation 679/2016/EU.

The processing of personal data is carried out using both paper and IT tools and media.
The Data Subject may exercise the rights provided for in Articles 15, 16, 17, 18, 20, 21 and 22 of Regulation 679/2016/EU.
The complete information notice drafted pursuant to Articles 13 and 14 of Regulation 679/2016/EU is available at the offices of the Entity and may be consulted on the website of the Entity at www.comune.monza.it or on the website of the Musei Civici di Monza at www.museicivicimonza.it.
Data Controller: Comune di Monza - Piazza Trento e Trieste - 20900 Monza.
The Data Protection Officer - DPO (Art. 13.1.b Regulation 679/2016/EU) identified by the entity can be contacted at the email address dpo@comune.monza.it.