Suggested wording for declaration forms for published and unpublished works.
Model copyright declaration forms
Publicly accessible libraries, archives, museums and galleries supplying a reasonable proportion of a published copyright work, or the whole or part of an unpublished work for users need to ensure that a declaration in writing is received and acknowledged by the person to whom they are supplying a copy. This may be as a declaration form or by other means, including email.
LACA has produced guidance on this, together with suggested wording for the forms.