DMCA Complaint Form

PolicyTech provides this form as sample to enable you to report copyright infringement, and for purposes of requesting the removal of copyrighted content
only because the material is copyrighted and the person who posted the content did not have the right to post the material. It is
not to be used for other reasons, e.g., you believe that someone has posted content that is libelous to you, criticizes you, is untrue, that misuses your trademark, or because the content is from a competitor.

It is PolicyTech's policy to act to remove potentially infringing content, when it receives proper notices of alleged copyright infringement. This sample form shows the kinds of information that should be present in the usual DCMA "take down" notice. It is not intended to be a legal form, or to offer legal advice about what is or is not an infringement.

An "authorized statement" under specific legal criteria established by the United States Digital Millennium Copyright Act of 1998 (DMCA) is required to be in any notice that we must accept when it asks for the removal of your copyrighted document(s). In order to expedite this matter, you may use the form below, print it and then fax or mail it to PolicyTech using the contact on the PolicyShare™ contact page.

The form of notice specified below is consistent with the form suggested by the portion of the United States Digital Millennium Copyright Act known as the Online Copyright Infringement Liability Limitation Act or Section 512 of the DMCA (the text of which can be found at the U.S. Copyright Office Web Site).

You may fill in the fields of the form and attach wording similar to the "sample Authorized Statement". Once we receive your proper notice, we will remove the content as soon as possible. We are not required to send you any confirming message.

We respect the legal rights of authors, creators, and copyright holders and will remove or disable access to copyrighted material that is being infringed upon our receipt of a timely and complete notice letter. Please note, however, that under Section 512(f) any person who knowingly materially misrepresents that material or activity is a copyright infringement may be subject to liability for damages. If you are not sure whether material available online infringes your copyright, we suggest that you first contact an attorney. Be warned that making false claims of infringement may subject you to legal action.

Please print and fill out the form below. *Required fields. Then fax or mail it to the PolicyShare™ contact listed below:

____	I am the Exclusive Copyright Rights Holder
____	I am the Duly Authorized Representative of the Exclusive Copyright Rights Holder
	Title(s) of Copyrighted Material (including any identifying material):* URL(s) of Infringing Material on POLICYSHARE™
	___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________
Address:	___________________________________________________________________________________
Telephone Number:	___________________________________________________________________________________
Email Address:	___________________________________________________________________________________
Full Legal Name:	___________________________________________________________________________________
Signature:	___________________________________________________________________________________
	"Under penalty of perjury in a United States Court of Law, I state that the information contained in this notification is accurate.*"

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