permissions

Permission Request Form

This form should be used by all third parties (Licensee) to request permission from Embecta Corp. (“embecta”) to:

Reprint, republish or otherwise copy or distribute materials, e.g. printed documents, digital images, videos or other media, which are owned or controlled by embecta.

Use embecta's name in a press release or any other public document, including marketing and promotional materials.

Request access to the embecta logo files, Brand Standards, and other brand assets.

For any of the above requests please complete this form and click on “Submit”.

Describe in detail the material(s) for which you request permission to reprint 1000 character limit. Please e-mail the full-text of documents larger than 1000 characters to: copyright@embecta.com and reference "Permission Request."

Describe in detail for what purpose the material(s) will be used 250 character limit. Please e-mail the full-text of documents larger than 250 characters to: copyright@embecta.com and reference "Permission Request."

For what duration will the material(s) be used?

Do you have samples of the material(s) requested?

Yes

Name of contact at embecta

Date permission required:

Acceptance of Privacy Terms

embecta is committed to keeping your personal data protected and secure. More information on how we protect your personal data can be found in our Privacy statements and our Cookie Preferences policy.

Contact Information

First Name

Last Name

Organization

Name of Individual Authorized to Sign Permission Form (Signatory)

Relationship of Signatory to Licensee

Address 1

Address 2

City

Zip code

Country

Telephone

Signatory E-mail Address:

Relationship with embecta: