UNFILTERED Winner Affidavit and Tax Declaration

I, the undersigned potential prize recipient, declare under penalty of perjury, to the extent permitted by applicable law, that I satisfied all eligibility requirements applicable to my participation in UNFILTERED and that my participation complied with all governing documents.

I declare that the personal, tax, and banking information I provide is true, complete, and belongs to me or to the lawful payee entity I am authorized to represent.

I confirm that I own or lawfully control the rights necessary for the submitted materials and that no unresolved dispute, injunction, encumbrance, or third-party claim prevents YUME from administering my prize or using my materials and likeness as previously authorized.

I understand that prizes may constitute taxable income and that YUME may require tax forms, withholding documentation, taxpayer identification numbers, and residency or treaty certifications before release of prize value.

I accept responsibility for filing, reporting, and paying taxes, duties, levies, fees, and charges applicable to my prize unless a written YUME communication expressly states otherwise.

I acknowledge that YUME may withhold, delay, restructure, or decline prize fulfillment where required by law, tax compliance, sanctions screening, fraud review, inability to verify identity, or unresolved eligibility or rights issues.

Winner Name: _______________________________

Stage Name / Act Name: _______________________________

Country / Region: _______________________________

Tax Residence: _______________________________

Signature: _______________________________

Date: _______________________________

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