Sample Royalty Statement

RECIPIENT GENERATED TAX INVOICE: COPYRIGHT ROYALTY STATEMENT FROM: 01/10/2009 TO 31/12/2009

VISCOPY MEMBER: JOHN DOE

Gross Royalty

Service Fee

Royalty ex tax

GST

Royalty inc. tax

Royalty Paid

Rights Status: Copyright Licensing

ABN Supplied: 111 111 111 Tax Code: GST $144.00 $36.00 $108.00 $10.80 $118.80 $118.80

COPYRIGHT HOLDER: STATEMENT DETAILS:

Mr John Doe PO Box 1 Sydney NSW 2001

Title: Green Leaves, 1928, Publisher: ABC Museum

Publication : The Great Arts, 1900-2010, Print Run 200

$72.00 $18.00 $54.00 $5.40 $59.40 $59.40

Title: The orange door 1953 , Publisher: ABC Museum

Free exhibition postcards, Print run 150

$72.00 $18.00 $54.00 $5.40 $59.40 $59.40

Total royalties collected

during this period

Membership status of the artist;

copyright licensing and/or

statutory licensing

Service fee deducted to cover

Viscopy’s operating costs Total royalties to be

paid to you during

this period

Details of how the work was used