Docusign Envelope ID: 61C80079-5676-45D8-93C5-D3E586170D80
META
PAYOUT SOURCE TRANSFER ACKNOWLEDGEMENT
Meta Platforms, Inc. (f/k/a Facebook, Inc.) requires acknowledgment of the following (this “Acknowledgment”),
prior to transferring Payout Source(s) ownership from one financial administrator to another:
David Shipman
1. Transfer of the Payout Source. ___________________________________ (“Transferor - Payout Account
kiattisak saengsuk
Name”) and ___________________________________ (“Recipient - Payout Account Name”) acknowledge
and certify to Meta Platforms, Inc. (“Meta”) that for good and valuable consideration, Transferor has assigned all
of its right, title and interest in and to the Payout Source(s) set forth on Exhibit A to Recipient.
2. Transfer Instructions. Transferor and Recipient hereby authorize and instruct Meta to:
(a) take all action necessary to remove Transferor as the registered owner of the Payout Source(s) on the Meta
platform; and
(b) take all action necessary to register Recipient as the registered owner of the Payout Source(s) on the Meta
platform.
3. Representation and Warranty. Transferor and Recipient each represent and warrant that:
(a) Meta may rely without additional inquiry on the instructions set forth herein and can lawfully carry out the terms
of this Acknowledgement without the consent, approval, authorization or other permission of any third party;
(b)It is not (i) the target of any economic or trade sanctions or restrictions administered or enforced by the United
States (including the Office of Foreign Assets Control of the U.S. Department of the Treasury (“OFAC”), the U.S.
Department of State, and the U.S. Department of Commerce), the United Nations, the European Union or the
United Kingdom (hereafter “Sanctions”); (ii) located, organized, or ordinarily resident in any country or territory
subject to comprehensive Sanctions; (iii) or owned or controlled (as defined in the relevant Sanctions) by a
person(s) described in paragraph (i) or (ii), as a result of which such owned or controlled person(s) are subject to
the same prohibitions or restrictions as the person described in paragraph (i) or (ii); and
(c) the instructions set forth in this Acknowledgement are in compliance with Sanctions and do not evade or avoid,
have the purpose of evading or avoiding, cause a violation of, or attempt to violate Sanctions.
4. No Meta Warranty or Liability. Transferor and Recipient acknowledge that Meta bears no responsibility and will
not have any direct or indirect liability to transferor, transferee, or third parties for any losses, damages or other
issues Transferor, Recipient, or third parties may have or incur as a result of or arising from the Meta’s compliance
with the instructions given in this Acknowledgement or any other matter related to this Acknowledgment.
TRANSFEROR AND RECIPIENT ACKNOWLEDGE AND AGREE THAT META’S COMPLIANCE WITH THE
INSTRUCTIONS GIVEN IN THIS ACKNOWLEDGEMENT AND PERFORMANCE
HEREUNDER WILL BE PROVIDED ON AN “AS-IS” BASIS AND WITHOUT ANY EXPRESS OR IMPLIED
WARRANTIES BEING GIVEN BY META, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF
MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, INTEROPERABILITY AND
NON-INFRINGEMENT.
5. Meta Held Harmless. Transferor and Recipient agree to hold Meta, its affiliates, directors, officers, employees,
agents, and representatives harmless from any and all claims, damages, expenses, suits, losses, or liabilities
arising from, related to, or in connection with this Acknowledgement.
[Signature Page Follows]
Docusign Envelope ID: 61C80079-5676-45D8-93C5-D3E586170D80
Part 1 - Identification of Transferor
● Must be signed by the Financial Administrator Registered with Meta, the signature must be handwritten or placed using a valid electronic
signature tool
1 Transferor Payout Account ID:_________________________________________________________
221979110776511
● Payout account ID which is transferring the page/application
2 Transferor Payout Account Name:_______________________________________________________
David Shipman
● Must match Transferor’s company name on file
Walberto Rizo
3 Financial Administrator Name: ________________________________________________________
● Must match User account name of who is transferring the page/application
4 Transferor’s signature and date
Sign Here -> ____________________________________________ _____________________
09/24/2024
Financial Administrator’s Signature Date(MM/DD/YYYY)
Part 2 - Identification of Recipient
● Must be signed by the Financial Administrator Registered with Meta, the signature must be handwritten or placed using a valid electronic
signature tool
5 Recipient Payout Account ID:_________________________________________________________
405297675010865
● Payout account ID which is receiving the page/application
6 Recipient Payout Account Name:_______________________________________________________
kiattisak saengsuk
● Must match Recipient’s company name on file
7 Financial Administrator Name: ________________________________________________________
Walberto Rizo
● Must match the User Account Name of who is receiving the page/application
8 Recipient’s signature and date
Sign Here -> ____________________________________________ _____________________
09/24/2024
Financial Administrator’s Signature Date(MM/DD/YYYY)
Part 3 - Identification of Payout Sources (pages / applications to be transferred)
EXHIBIT A - PAYOUT SOURCES
221979110776511 10 Recipient Payout Account ID:______________________________
9 Transferor Payout Account ID : ________________________ 405297675010865
12 Payout Source ID 13 Product type
11 Payout Source Name (pages/applications name) (pages/applications ID)
Liberty Tucker 100093592916328 Ad Breaks
Liberty Tucker 100093592916328 Subscriptions (Web)
