26 L.1. 1962 COPYRIGHT REGULATIONS, 2010 SECOND SCHEDULE REPUBUC OF GlL\NA APPLICATION FOR PURCHASE OF SECURITY DEVICE (regulation 7 (1)) COPYRIGHT OFFICE (ANfI-PIRACY) FORM C APPLICATION FOR lHE PURCHASE OF SECURITY DEVICE Name of Producer Address Title of work for which security device is being procured No of 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 I1We declare on my/our honour that the information given above is true to the best of my/our knowledge and belief and that any misinformation given by me/us renders my/our application null and void, Year Day Month __________~Ionl~__~______~____~ Declared at ~ Applicant:~ signature • Authorization from the author/right owner of the work to produce the said work(s) for which the approval for application of security device is being sought mu,t be aI/ached.