24
LI. 1962
COPYRIGHT REGULATIONS, 2010
SECOND SCHEDULE
REPlJBlJC 01-' Glt\N·\
APPLICATION FOR APPROVAL OF SECURITY DEVICE
(regulation 5 (3))
FORM A
ANTI-PIRACY
APPLICATION FOR THE APPROVAL OF SECURITY DEVICE
Name of Producer
Address
Title of work for which approval of security device is being sought 1
..._ _ _ _ _ _ _ _-'
Security device required
Name(s) ofauthor(s) of work
Has the producer obtained the consent of the author/composer to produce and/or reproduce
the work?
Yes
D
NoD
I1We declare on my/our honour that the infonnation given above is true to the best of my/our
knowledge and belief and that any misinfomiation given by me/us renders my/our application
null and void.
Year
Day
Month
Declared at
Applicant s signature
*A"thori=ation from the author/right owner of the work to produce the said work{s) for which the approval
for upp!icaIion vf security del'it.,:e is being soughl must be attached.