1.
Full name of the
applicant:…………………..
(In Block Letters)
2.
Full address and nationality of
the applicant: …………………..
3.
Telephone/ Fax/E-mail
:……………………………………..
4.
Description of the work:
(a)
Class of the work (Literary
,Dramatic, Musical, Artistic, Cinematograph Film, Sound Recording);
(b)
Title of the work;
(c)
Full name, address and
nationality of the author and if the author is deceased, the date of his
decease;
(d)
Language of the work;
(e)
Name, address and nationality
of the publisher;
(f)
Year of first and last
publication;
(g)
Country of first and last
publication;
(h)
Price of a copy of the work;
(i)
If the copyright in the work is
registered under section 45, the Registration Number, if known.
5.
If the licence is applied for
translation, state:
(a)
Language into which the work is
proposed to be translated;
(b)
Full name, qualifications and
address of the translator;
(c)
Qualifications of the applicant
to produce and publish the translation.
6.
Indicate the purpose for which
the licence is required.
7.
Number of copies of work
proposed to be published under the licence applied for.
8.
Estimated cost of the work to
be published.
9.
Proposed retail price per copy
of the work.
10.
Rate of royalty, which the
applicant considers reasonable, to be paid to the copyright owner.
11.
Means of the applicant for
payment of the royalty.
12.
Whether the prescribed fee has
been paid and, if so, particulars of payment (give postal order/Bank Draft/Treasury
Challan number).
13.
(a) Full name, address and
nationality of the person competent to issue a licence;
(b) Whether the applicant after due diligence on his part was unable
to find the owner;
(c) Whether the applicant has
requested and had been denied authorization by the said person to to produce
and publish the translation or reproduce the work of publish the unpublished
work;
(d)If the applicant was
unable to find the owner, whether he had sent a copy of the request by
registered post to the publisher whose name appears on the work. If so, the
date on which the copy was sent.
14.Whether
the author of the works has withdrawn from circulation copies of the work.
15.In
case of application for translation furnish following additional information:-
(a)
Whether a translation in the
same language has been published before;
(b)
Whether the earlier translation
is out of print;
(c)
Full name, address and
nationality of the earlier translator and if the said translator is deceased,
the date of his decease;
(d)
Title of the earlier
translation;
(e)
Full name, address and nationality
of the publisher of the earlier translation;
(f)
Year of publication;
(g)
Price per copy of the earlier
translation;
(h)
If the earlier t5ranslation is
registered under section 45, the Registration Number if known;
(i)
Rate and amount of royalty paid
to the copyright owner in respect of the earlier translation, if known.
16. (a) Whether translation has been made into
any language other than the language stated in 5 above.
(b)Full name, address and nationality of the translator and if the
said translator is deceased, the date of his decease.
(c)
Title of the translation.
(d)
Language of the translation.
(e)
Full name, address and nationality of the publisher of the translation.
(f) Year
of publication.
(g)
Price per copy of the translation.
(h)
If the translation is registered under section 45, the Registration Number, if
known.
(i)
Rate and amount of royalty paid to the copyright owner. If known.
17. Remarks, if any.
18. List of enclosures.
Place…………………
Date………………….
……………………
(Signature)
