APPENDIX 1 FORM 1 NIGERIAN COPYRIGHT COMMISSION COPYRIGHT (DISPUTE RESOLUTION PANEL) RULES 2007 Notice of Reference under Rule 2 (1) To, The Director General Nigerian Copyright Commission TAKE NOTICE that [name and address of prospective Applicant] ("the Applicant"), being the prospective licensee/licensor under a licence to be granted by [name and address of the licensor] in favour of [name and address of the licensee] hereby refers to the Nigerian Copyright Commission a dispute in respect of the said licence pursuant to Paragraph 15(1) of the Copyright (Collecting Societies) Regulations 1993, for resolution by a Tariff Arbitration Panel. The Applicant’s Point of Reference is/are: {state briefly the nature of dispute and determination sought} There is delivered herewith a statement of the Applicant's case. All communications about this reference should be addressed to the Applicant at the address shown above. Persons involved in the dispute are: {State name and address of the Respondent(s)} Dated the day of 20 [Name and address of Applicant's solicitor/agent]. Signed .......... Status of signatory .......... [Applicant, an officer of Applicant, solicitor or agent]