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OFFICIAL ENTRY FORM

Sining PSE : The Philippine Stock Exchange 2012 National Art Competition

Entry Form

Please print all pertinent information clearly and legibly.

Artists’ Name :

Full Mailing Address :

2 x2 inches colored photo of artist

5 x7inches photo of artwork

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Tel/Mobile Number :

Date of Birth :

TIN / GID :

Title of artwork :

Category/Medium :

Date Started/Finished :

Size :

Artist’s Statement (Use separate sheet if necessary.)

(in 500 words or less) :

I declare under oath that the abovementioned artwork was conceived and executed exclusively by myself as the artist for the purpose of participating in the Sining PSE Competition. I shall allow Philippine Stock Exchange free use of the image of my artwork for publicity and/or marketing purposes. I have read and shall abide by all the rules and regulations imposed by the PSE in the pursuit of this Competition. Any violation due to technical deficiencies of my artwork, as stipulated in the rules, shall be grounds for the disqualification of my artwork.

I hereby acknowledge that should my entry be chosen among the top 10 finalists and/or win the Sining PSE Competition (“winning entry”), any and all rights and interests pertaining to the winning entry shall pertain to the PSE. I hereby unequivocally assign all my rights and interests over the winning entry, whether vested, contingent or future and all rights of action and all other rights of whatever nature in and to my entry, whether now existing or in the future created, to which I now or may in the future be entitled by virtue of or pursuant to any law, in favor of the PSE, including, but not limited to, the ownership of the copyright and the material object.

In addition, I hereby acknowledge that should my entry not be chosen among the top 10 finalists or win the Sining PSE Competition, and I fail to claim said entry by December 1, 2012, I shall be automatically be deemed to have assigned any and all rights and interests pertaining to the unclaimed non-winning entry shall pertain to the PSE. I hereby unequivocally assign all his rights and interests over the unclaimed non-winning entry, whether vested, contingent or future and all rights of action and all other rights of whatever nature in and to my entry, whether now existing or in the future created, to which I now or may in the future be entitled by virtue of or pursuant to any law, in favor of the PSE, including, but not limited to, the ownership of the

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copyright and the material object , with full authority for the PSE to dispose of the same in any manner it may deem fit.

__________________________________________________ Signature over printed name of participant AFFIDAVIT I, _________________________________, Filipino, ______ years old, single/married and residing at ___________________________________ after having been duly sworn in accordance with the law, hereby depose and state that:

1. I am joining Sining PSE : The Philippine Stock Exchange 2012 National Art Competition and in connection therewith, I am submitting as my official entry, the painting/sculpture entitled “___________________________”, herein called the “ENTRY”.

2. The ENTRY is my original and exclusive creation, being the result of my intellect and labor alone, and has not been copied from nor is similar to any previous or existing artwork (painting or sculpture) in terms of composition or otherwise, even if rendered in a different style, medium or color scheme.

3. The decision of the Board of Judges as to whether my ENTRY is original shall be final and I bind myself to abide by the said decision.

4. I began work on the above-stated ENTRY on _________________ and completed and readied the same for competition on __________________.

5. I unconditionally consent to the use of my winning entry for PSE collaterals which includes annual reports, wall calendars, desk calendars, all-occasion cards, and other products/items, and media without liability on the part of, or cost or fee to be paid by PSE.

6. If I fail to retrieve my ENTRY after the date specified in the rules, then I agree that it shall automatically become the property of PSE.

7. I have read and I will abide by the rules, regulations and requirements governing the above-mentioned competition and, in this regard, I hereby exempt, discharge, release and free PSE and its directors/trustees/officers and staff and shall defend and hold them free and harmless from any claim, liability or legal action arising from any potential or actual loss or damage arising from breach of falsity of any of my representations, acceptances or undertakings herein and from any claim or liability from any loss or damage which my ENTRY may suffer while being transported or while otherwise in the custody of PSE.

I am executing this affidavit to attest to the truth, veracity and validity of all the foregoing and to certify, under oath, originality, authenticity, and ownership of my above-mentioned ENTRY, under plain of perjury. In witness whereof, I have hereunto set my hand this ____ day of _____ 2012, in the City/Province of ____________________.

__________________________ AFFIANT

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Republic of the Philippines

SUBMITTED AND SWORN TO before me this ____ day of ______________________ 2012, in _________, affiant exhibiting his/her Community Tax Certificate No. _______, Issued at _____________________ on __________, 20______________.

Doc. No : ________________________

Page No: ________________________

Series of 2012 ________________________