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Full Name *
Full legal name of the copyright holder you represent (e.g., if you are a legal agent, etc.) *
Email Address *
Mailing Address *
Phone Number *
Website Domain *
URLs of the allegedly infringing image/s or Website content item/s (separated by comma) *
Example of the copyright work allegedly being infringed *
Additional comments about the allegedly infringing: *
Your relationship to the copyright holder *
I hereby declare (Please check to confirm) *
Type your name to provide your digital signature *
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