1.

Registration number (To be filled in the Copyright Office)

2.

Name, Address and Nationality of the Applicant

3.

Nature of the applicant’s interest in the copyright of the work

4.

Class and description of the work

5.

Title of the work

6.

Language of the work

7.

Name, address and nationality of the author and, if the author is deceased, the date of his decease

8.

Whether work is Published or Unpublished

9.

Year and country of first publication and name, address and nationality of the publishers

10.

Years and countries of subsequent publications, if any, and names, addresses and nationalities of the publisher

11.

Names, address and nationalities of the owners of the various rights comprising the copyright in the work and the extent of rights held by each, together with particulars of assignment and licenses, if any

12.

Names, addresses and nationalities of other persons, if any, authorized to assign or license the rights comprising the copyright

13.

If the work is an “artistic work”, the location of the original work, including name, address and nationality of the person in possession of the work. (In the case of an architectural work, the year of completion of the work should also be shown)

14.

If the work is an ‘artistic work’ which is used or is capable of being used in relation to any goods or services, the application shall include a certificate from the Registrar of Trade Marks in terms of the proviso to sub-section (1) of section 45 of the Copyright Act, 1957.]

15.

If the work is an “artistic work” whether it is registered under the Designs Act 2000. If yes give details.

16.

If the work is an “artistic work” capable of being registered as a design under the Designs Act 2000, whether it has been applied to an article though an industrial process and , if yes, the number of times it is reproduced.

17.

Remarks, if any