8th Fe bruary, 20G8 5 (reg. 12) PART III CO PYRI G HT A CT (C AP_49 :0 3) FOK.'vI C APPLICATIO:-: TO Pt.:RCHASE HOLOCiRA\1 FROY! THE COPYRIGHT SOCIETY OF \1ALAWI I. :\ame of Impol1er/Applieanl : _ 2. Address: .. .... _.. _.. _.. __._ ...... . _..... _. Te lepho ne ~ umb c r 3. ~ u lnbc r: ....... __ ... __ ......... ..... ...... .... ............. .. Fax : .............. ....... ........... . of holograms required : ..... .... ...... ..... . _.... .... ___ .. .. . _._ .. _._ ... _...... _. _, .. . _.... ,...... ..... _... 4. Xa me of author(s) of work: ... _..._......._..._...._._ ....._._ . ____ __._. __ .______ ._. __.._._ .. ..._...... _........_.. ._.. 5.-{ I) Has im porter obtained the autho ri zatio n of the producer or h is authorized repre scntantive to impol1 the said work(s ): Yesl:\o. (2) If yes picase anach evidence. 6 . Declaration: I/\Ve declare on my/our honour th at the infonnation g iven above is true to the best of my/o ur kn o wledge and that any misinfo nn ation previded by me/ us renders my/our application null and void . Declared at ._._. __ ____ .__ ___________ .____ __ ..................... .. on __ _____ .__ ..... ___ ._._ .. 20 ___ ._. Sg nalUre of App/icon/ "OTE: I. Genuine ho log ram of th e country o f orig in of tbe impor.ted works affix ed on to the work s; or 2 . Authe ntic ation from the producer of the work to import the work(s) for which this approval is being soug ht. PART IV (r-eg_ I;; ) COPYRIGHT ACT (CAP. 49:03) fORYt D ApPROVAL TO PCRCHASE HOLOGRAMS FROM TIlE COPYRIGHT SOCIETY OF MALAWI Approval is hereby given to: ______ ___ ..______ ._ .. __ ... ......... .. .... __ ... __ .... :_ of ...__ ........ __ _..._............ ...... ..... ....... .... ..... .. ... .... ...... ... .......... to pur-cnase ............... ............. .... _....... ... .... holograms