Request for permission to include [figure/image/graph/etc.] in PhD thesis

Dear [Copyright owner’s name]

[Introduce yourself and insert a bit of background about your thesis].

I am writing to request permission to use the material/s listed below in my thesis [insert thesis title] at the University of Western Australia.

Theses published at the University of Western Australia are made digitally available on the internet for public access via the UWA Research Repository which is indexed by TROVE, the National Library of Australia’s discovery service.

My thesis includes the following copyright material which I believe you hold the copyright to.

Material to be reproduced

Title of Publication: xxx

URL if applicable: http://

[Add here full citation information about the figure/image/etc., including author, title, date of publication, exact image number (if known), and any other identifying information]

This request is for worldwide, non-exclusive, perpetual, and royalty-free permission to reproduce and use the material/s in the electronic and print copy of my thesis to be made available in the UWA Research Repository. Full attribution will be included; please specify if there is a particular way that you would like me to give attribution to the original source:

If you require any additional information, do not hesitate to me in the first instance at [insert email address], or by phone on [insert phone number – not compulsory].

Kind regards,

[Insert name]

Material to be reproduced

Title of Publication: xxx

URL if applicable: http://

[Add here full citation information about the figure/image/graph/etc., including author, title, date of publication, exact image/graph number, and any other identifying information]

As Rightsholder of the material/s stated above, I give worldwide, non-exclusive, perpetual, and royalty-free permission to reproduce and use the material/s in [thesis title].

In signing, you verify that you control the rights granted and that your material does not infringe any other entity’s copyright or other rights.

SIGNED for and on behalf of, ______________________________________________________

(name of Rightsholder)

on the ________ day of _________________________ 2021, by

____________________________ (Signature / Name)