Image ID: 143020625

MODEL RELEASE FOR ADULT

Date: 2019-06-18 01:13:32.0

My name is Nabilla Anggundari.

My address is Tanah Lot street , Tabanan, Bali, ID, 82111.

I am fully contractually capable.

For the following Image 143020625 displaying my picture, (hereinafter referred to as "Image Material"), I make the
following declaration:

I hereby confirm that I am willing to grant the photographer the irrevocable right (that may be transferred to third
parties) to use the Image Material without any restriction of time, content or territory and to transfer this right for
utilisation, in whole or in part, to third parties (hereinafter referred to as "Entitled Persons"). These are in particular
Eyeem Mobile GmbH, Kohlfurter Strasse 41/43, 10999 Berlin, Germany (hereinafter referred to as "EyeEm"), companies
affiliated with EyeEm as well as their customers.

If the Image Material has been created in a protected area (apartment, a fenced area) that is part of my private sphere, I
herewith confirm that I am the solely authorised person who may decide whether or not these Images from/in the
protected area may be used.

This authorisation covers all the rights of use required for the comprehensive utilisation and processing of the Image
Material by the photographer or by the Entitled Persons. The authorisation shall continue to be valid even after my
death.

The authorisation must include, among others:

 The reproduction right
The distribution right
The right of public accessibility
The transmission right and broadcasting right
The right to call up, and use online
The right to process or otherwise change the Image Material, e.g. that the Image Material may be combined,
edited or changed with other images, text and graphics, films, audio and audio-visual media.

The permission for using the Image Material applies to every purpose, in particular, but not exclusively, advertising and
marketing purposes and other commercial uses.

The use of the Image Material is permitted in any context - except for pornographic or defamatory contexts.

I have received an appropriate financial compensation for taking the photographs and the rights granted in this release.
The receipt of this remuneration is acknowledged hereby. Thus, all possible claims against EyeEm and their customers
have been settled.

Where copyrights, performance protection rights or other rights have arisen due to my participation in the creation of
photographs, to which I am entitled, the aforementioned declarations shall apply accordingly.

I understand that the Image Material is used without mentioning my name and that it cannot be excluded, however, that
on individual photographs I might be identifiable.

I recognise explicitly that there is no obligation to mention my name when reproducing the Image Material.

I have given all necessary declarations as required by data-protection law to the photographer; I am also aware that the
photographer may store my data and use them for the purposes mentioned here in connection with the Image Material,
e.g. in order to defend himself against any third-party claims or to secure claims.

I have understood the above Declaration and agree to its entire content. I certify that the information I have given is true
and correct.

I have read the Privacy Policy for Releases (http://dl.eyeem.com/market/privacy_policy_for_releases.pdf) and agree to
their entire content.

MODEL INFORMATION

Name: Nabilla Anggundari

Date of Birth: 1998-08-18
Gender: FEMALE
Residence address: Tanah Lot street
City: Tabanan
State/Province: Bali
Country: ID
Zip/Postal code: 82111
Phone (optional):
Email: nabilaanggun18@gmail.com

PHOTOGRAPHER INFORMATION

Name: Bagoes Budi Noer C

Residence address: Desa Medalem Rt 01 Rw 01 Kecamatan Tulangan, Rumah yang ada studio fotonya depan puskesmas
pembantu medalem
City: Sidoarjo
State/Province: Jawa TImur
Country: ID
Zip/Postal code: 61273
Phone (optional):
Email: bagoesbudinoerc@gmail.com
Date of Shoot: 2019-06-18 00:55:45.0