24 LI. 1962 COPYRIGHT REGULATIONS, 2010 SECOND SCHEDULE REPlJBlJC 01-' Glt\N·\ APPLICATION FOR APPROVAL OF SECURITY DEVICE (regulation 5 (3)) FORM A ANTI-PIRACY APPLICATION FOR THE APPROVAL OF SECURITY DEVICE Name of Producer Address Title of work for which approval of security device is being sought 1 ..._ _ _ _ _ _ _ _-' 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 NoD I1We declare on my/our honour that the infonnation given above is true to the best of my/our knowledge and belief and that any misinfomiation given by me/us renders my/our application null and void. Year Day Month Declared at Applicant s signature *A"thori=ation from the author/right owner of the work to produce the said work{s) for which the approval for upp!icaIion vf security del'it.,:e is being soughl must be attached.