8/17/2019 CW Copyright Form

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 Date: --/--/----

To

Dr. Amitendu Bhattacharya

Instructor-in-Charge

Course No. GS F2!" Course Tit#e: Creati$e %riting

Semester 2" Academic &ear 2'!(-2'!)

BITS *i#ani" +.+. Bir#a Goa Cam,us

Sir"

Sub: Declaration of Originality &Assignment of Copyright

I" Ahas,adhayay2'!A0*S(!0G1

  

3u## name o3 author 4ith ID No.1" the co,yright o4ner o3 the enc#osed ,iece o3 creati$e 4riting

,oem/ short story/ creati$e non-3iction: tic5 the a,,ro,riate category1" tit#ed

 6666666666666666666666C7AND8A9ATI666666666666666666666666666666666666666666 

 6666666666666"

do herey dec#are that I am a registered ,artici,ant o3 the course GS F2!: C8;ATI9;

%8ITING< and that this is an origina# 4or5 sumitted in ,artia# 3u#3i##ment o3 the re=uirements

o3 the course. I3 on care3u# scrutiny you ad>udge the ao$e-said ,iece to e remar5a#e in sty#e"content and origina#ity o3 thought" I authori?e you to ,u#ish it under my name in any oo5/

antho#ogy/ >ourna#/ maga?ine o3 your choice.

I 3urther state that:

!. This 4or5 does not in3ringe on the co,yrights o3 others and does not contain any #ie#ous

or un#a43u# statements.

2. %here$er re=uired I ha$e ta5en ,ermission and ac5no4#edged the origina# source.

@. The 4or5 has een sumitted on#y to BITS *i#ani and that it has not een ,re$ious#y

 ,u#ished or sumitted e#se4here 3or ,u#ication either in ,art or 4ho#e.

I herey ,ermit you to edit" a#ter" modi3y and ma5e changes in the 4or5 to ma5e it suita#e 3or 

 ,u#ication.

I herey assign a## the co,yrights re#ating to the said 4or5 to the Instructor-in-Charge and BITS

*i#ani ni$ersity and a33irm that I ha$e not assigned any 5ind o3 rights o3 the 4or5 to any other  ,erson or ,u#ications.

I agree to indemni3y you and BITS *i#ani ni$ersity against any c#aim or action a##eging 3acts"

4hich" i3 true" constitute a reach o3 any o3 the 3oregoing 4arranties.

 Name :Ahas ,adhayay

Signature :

8/17/2019 CW Copyright Form

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