Name of All Partners (Only in case of Partnership Firms)
Applicant Name (Firm/Company/Trust/Society/Individual)
Constitution of Applicant (In case of Non Individual Applicants)
ProprietorshipPartnershipPvt. Ltd.Trust / Society
Full Name of the Signatory
Designation of the Signatory
Registered Address
Correspondence Address
Mobile Number
Landline Number
Language of Work
Type of Work (For e.g.: Artistic work, Books Etc.)
Brief Description of Work
Author of the Work (Please include the names of all Persons Involved in the work)
Author Address
Year of First Publication
Country of First Publication
Is the Applicant the Publisher (If no please provide the details in Below Fields)
YesNo
Name, Address, Constitution and Nationality of the Publisher. (First Publication)
Publisher Name (Current Publisher If different from that of First Publisher)
Publisher Address (Current Publisher If different from that of First Publisher)
Constitution of Publisher (Current Publisher)
ProprietorshipPartnership
(In case of Non Individual Applicants)
Pvt. Ltd.Trust / Society
Material for Copyright Enclosed
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Form Submitted By (below details required for communication purpose only and will be not included in registration)
Full Name
Phone Number with Country Code
Email Address
Additional message if you have any. (Optional)
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