Royalty Reporting Template

ROYALTY REPORTING TEMPLATE

This Royalty Report and accompanying statements are submitted pursuant to the Royalty Agreement between the parties identified below.

Parties and Effective Date

Licensor Name:

Licensee Name:

Agreement Effective Date:   Report Reference No.:

Recitals

WHEREAS, Licensor owns or controls certain intellectual property, products, or content licensed to Licensee for commercialization as set forth in the parties' license agreement; and

WHEREAS, Licensee sells or otherwise exploits the licensed subject matter and is required to deliver periodic royalty reports and payments to Licensor in accordance with the terms of the license agreement; and

WHEREAS, this report constitutes Licensee's sworn statement of sales, receipts, deductions and royalties for the reporting period stated below.

Scope of Work / Description of Licensed Activity

Reporting Period and Frequency

Reporting Period From:   To:

Monthly    Quarterly    Annual    Other:

Statement of Royalties

Currency of Report:

Units Sold:   Gross Receipts:

Permitted Deductions (short description):

Net Receipts After Deductions:   Royalty Rate:

Royalty Due (Net Receipts × Royalty Rate):   Adjustments and Prior Credits:

Payment Terms

Payment Amount Due:   Due Within (days after report):

Late Payment Interest/Charge:   Minimum Late Fee:

Term and Termination

Term Start Date:   Term End Date:

Termination Notice Period (days):

Upon termination or expiration of the license agreement, all outstanding reports and payments shall remain due and payable in accordance with the payment provisions herein. Termination shall not relieve Licensee of obligations to produce final reconciliations or to permit audits covering any period prior to termination.

Confidentiality

The reporting party acknowledges that the information contained in this report may constitute confidential business information under the parties' confidentiality obligations. Unless otherwise permitted by the license agreement, recipient shall maintain confidentiality and use the report solely for purposes of administering the licensing relationship.

Mark any confidential sections: This report contains confidential information subject to nondisclosure.

Audit Rights and Records

Licensee shall retain, and permit Licensor to audit, complete and accurate books and records supporting the statements in this report for a period of at least three (3) years following the end of the reporting period, or a longer period where required by contract or law.

Audit requested: Licensor may exercise audit rights as provided in the license agreement. Licensee shall remedy any underpayment discovered within thirty (30) days of final audit determination, plus interest as stated above.

Representations and Certification

By submitting this report, the undersigned certifies under penalty of perjury that the information provided herein is true, complete, and accurate to the best of their knowledge and that all calculations were performed in accordance with the license agreement.

Governing Law; Entire Agreement

This report and any payment obligations arising from it shall be governed by the substantive laws of the state specified in the underlying license agreement without regard to its choice-of-law rules. This report, together with the license agreement and any written amendments, constitutes the entire agreement between the parties with respect to reporting and payment of royalties and supersedes all prior contemporaneous understandings and agreements, whether written or oral, relating to the same subject matter.

Additional Notices

If there is an overpayment, Licensor may elect to refund the amount or apply the credit to future royalties, consistent with the license agreement. Any underpayment discovered outside of audit will be payable with interest and any reasonable costs of collection.

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