23
L.t. 1962
COPYRIGHT REGULATIONS, 2010
CINEMATOGRAPIIIC WORKS
VIDEO FORMAT
K
C'INEMATO
GRAPHY
I
I
CELLULOID
I
NAME OF SCRIPT WRITER
ADDRESS.
NAME OF PRODUCER
ADDRESS.
I
DO YOU HAVE ABOVE NAME CONSENT BEFORE FILMING THE SCRIPT YES
(You are required to provide
docu~entary
NO
evidence in all cases)
(kindly provide the documentary agreements)
Number of Performers.
.. I, the undersigned, hereby certify that I am the (Tick one)
CERTIFICATION:
( ) author/composer ( ) producer/publisher ( ) O\Hlcr of execJusive rig:ht OR
( ) authorised agent of:
(name of author/other copyright claimant/exclusive right
Hand\\ntten signature (x) ....
Typed or printed name
STAMP OF RECEl\'ING OFFICE
Date
Q\\l1er)