ICT Policy Africa

PARTD
APPLICATION FOR REGISTRATION OF A LICENCE OF RESERVED
WORK,S OF FOLKLORE
CNRFORM4

FOR OFFICIAL USE

Section(s)-85 of Act
Section(s) 13 of Regulations
Received on: .............., ..................

APPLICATION FOR REGISTRATION OF .
A LICENCE
IN TERMS OF SECTIOJ'J 85 OF THE ACT
TO: Registrar of Copyright and Neighbouring Rights

HARARE

Licensee'slAgen! ref: ........

I. In the matter <if application for registration'of a licence in terins of section 85 of
the Act
Registration No: .......................,............ .

Filing date: ..................... :.............. ..

"ride of work: ......................... :.: ............

Registration date: ...........:................ .

Category ofworic.: ......... :............................................................................:............ .
2.

.

OwnerslI...iceasee name: ....................................... :.; ........................ :............ :........... .
Address: .. ,..................................... _...............: ........,: ............. :............................... ..

,'..................................................................................... :, ............................ .

3.

Licensee's name: ................. :........ :......... ..

Nationality: ................................... ..

Address: ...................................................:..........................." ........ .............................. _.
DomiciJelPrincipai place of b~siness: ....... :..... :........................................................ .
4.

APPLICATION
"

(8)

'I1!e licensee(s), hereby applies(y} for the registration of the licence in respect of the
above-identified reserved mark(s) of the folklore subject 10 the folJowil)g contition(s).

(b)

UWe are entitled 10 the reserved work of folldbre by virtue of:

o

D

the accompanying licence.
Any other document specify.

5. . THUSOONEANDSIGNEDAT.....": .......... this .... :..........dayof ............. 20...:........... .
Address for service: ............ :....................... ..
Applicant(s)/Agent for applicant(s)