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L.1. 1962
COPYRIGHT REGULATIONS, 2010
SECOND SCHEDULE
REPUBUC OF GlL\NA
APPLICATION FOR PURCHASE OF SECURITY DEVICE
(regulation 7 (1))
COPYRIGHT OFFICE (ANfI-PIRACY)
FORM C
APPLICATION FOR lHE PURCHASE OF SECURITY DEVICE
Name of Producer
Address
Title of work for which security device is being procured
No of 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
I1We declare on my/our honour that the information given above is true to the best of my/our
knowledge and belief and that any misinformation given by me/us renders my/our application
null and void,
Year
Day
Month
__________~Ionl~__~______~____~
Declared at
~
Applicant:~
signature
• Authorization from the author/right owner of the work to produce the said work(s) for which the approval
for application of security device is being sought mu,t be aI/ached.