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Get Check Authorization Form For Actors

SAG-AFTRA TALENT CHECK AUTHORIZATION FORM For work in Legacy AFTRA s jurisdiction TO SAG-AFTRA I HEREBY AUTHORIZE AND DIRECT SAG-AFTRA TO DELIVER ALL CHECKS OR SUMS OF MONEY PAYABLE TO ME TO THE FOLLOWING ADDRESS Agency Name Address This authorization shall remain in effect until written notice of the revocation thereof executed and acknowledged by me and received by SAG-AFTRA with a copy to the agency listed above. me with this agency or any other agency for the areas initialed by me below. DATE ARTIST S SIGNATURE SOCIAL SECURITY NUMBER ARTIST S NAME PRINTED OR TYPED SS or SAG-AFTRA ID THIS AUTHORIZATION IS LIMITED TO THE FOLLOWING AREAS ONLY ARTIST MUST INITIAL the line to the left of each applicable area* Please circle OC On-Camera only or VO Voice-over only if applicable. If both OC and VO apply do not circle either. ALL CHECKS If this is initialed do not initial any other areas TV PROGRAMS Original payments OC VO NON-BROADCAST OC VO TV Programs original payment NO BACKGROUND WORK TV PROGRAM RESIDUALS commissionable only INFOMERCIALS OC VO TV RESIDUALS commissionable non-commissionable INTERACTIVE OC VO DAYTIME DRAMA Original Payments only RADIO PROGRAMS PROMOS OC VO BROADCAST/NEWS VOICE-OVERS ALL areas HOSTING ON-CAMERA COMMERCIALS INTERSTITIAL RADIO COMMERCIALS BILLBOARDS OC VO SOUND RECORDINGS OTHER Specify below SPECIFIC ENGAGEMENT AUTHORIZATION This authorization shall apply to the following specific engagement only LA SAG-AFTRA Professional Representatives Dept. me with this agency or any other agency for the areas initialed by me below. DATE ARTIST S SIGNATURE SOCIAL SECURITY NUMBER ARTIST S NAME PRINTED OR TYPED SS or SAG-AFTRA ID THIS AUTHORIZATION IS LIMITED TO THE FOLLOWING AREAS ONLY ARTIST MUST INITIAL the line to the left of each applicable area* Please circle OC On-Camera only or VO Voice-over only if applicable. If both OC and VO apply do not circle either. ALL CHECKS If this is initialed do not initial any other areas TV PROGRAMS Original payments OC VO NON-BROADCAST OC VO TV Programs original payment NO BACKGROUND WORK TV PROGRAM RESIDUALS commissionable only INFOMERCIALS OC VO TV RESIDUALS commissionable non-commissionable INTERACTIVE OC VO DAYTIME DRAMA Original Payments only RADIO PROGRAMS PROMOS OC VO BROADCAST/NEWS VOICE-OVERS ALL areas HOSTING ON-CAMERA COMMERCIALS INTERSTITIAL RADIO COMMERCIALS BILLBOARDS OC VO SOUND RECORDINGS OTHER Specify below SPECIFIC ENGAGEMENT AUTHORIZATION This authorization shall apply to the following specific engagement only LA SAG-AFTRA Professional Representatives Dept. .

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