Mexico, Federal District, ,20____. INSTITUTO NACIONAL

Mexico, Federal District,_______________,20____.
INSTITUTO NACIONAL DEL
DERECHO DE AUTOR
I, the undersigned, _
(Name of author)
, state under oath that l grant a non-exclusive
license for an open period of time, so that the work entitled_
(little or work)_____ , of which
I am the author is published in the electronic journal Leaa Lenguas en Aprendizaje
Autodirigido. Revista Electrónica de la Mediateca del CELE UNAM, published by the
Universidad Nacional Autónoma de México through the Centro de Enseñanza de Lenguas
Extranjeras. This license is granted to cover the printed form and electronic media such as CDROM.
Moreover, as I am aware that the distribution of the above mentioned journal is a non-profit,
academic endeavor, I grant authorization for dissemination to take place on electronic media,
both on local network and on the Internet.
Sincerely,
___________________________
Full name or author
___________________________
Author’s signature
___________________________
Nationality
___________________________
Federal Taxpayer’s number
____________________________
Citizen’s ID number
_____________________________
Place and date of birth
______________________________
Address