Academic Journal Artwork Permission Form
1. Journal & Article Information
Journal Title
Article Title
Author(s)
Corresponding Author Email
Manuscript Number (if available)
2. Artwork Description
Figure/Table/Artwork Number or Title
Brief Description
3. Source Details
Original Source (e.g., journal, book, website)
Publisher
Publication Year
Author/Artist (if different from above)
4. Permission Details
Permission obtained from
Date Permission Granted
Type of Permission
Additional Notes (if any)
5. Declaration
I declare that I have obtained the necessary permissions to use the artwork described above in the journal article indicated, and I take full responsibility for compliance with copyright regulations.
Author Name
Signature
Date
Permission Holder Name
Signature
Date