Foreign Rights Royalty Statement

Author Name:
Title of Work:
Statement Period:
Date Issued:

Foreign Rights Income Details

Licensee / Publisher Territory Language Rights Type Contract Date Gross Amount Deductions Net Receipts Author's Royalty (%) Royalty Amount
Total Gross Receipts:
Total Deductions:
Total Net Receipts:
Total Royalties Due:

Remarks:

Prepared by:
Contact Information: