I hereby authorize Liberty Mutual Insurance Company, a Massachusetts stock insurance
company, its parent, subsidiaries and affiliates (“Liberty Mutual”) and its officers, agents, and
employees, to use my name and to print, reproduce or publish a photograph, portrait, video and
audio recording, or likeness (“Image”) of me taken on or about the above date. Liberty Mutual
may use the Image in perpetuity, alone or accompanied by other material, in any manner and in
any media throughout the world for the purposes of advertising and promotion or for any other
legitimate commercial purpose of Liberty Mutual. I hereby waive any right to inspect and
approve the finished Image.
*
