Name and address of registered owner(s) Name and address of new owner(s) Copyright registration number I/We, the applicant(s) identified above, hereby apply to have a change of ownership of the copyright work indicated above recorded in the Copyright Register for the above copyright work. The change of ownership was effected by: A deed of assignment Any other instrument (specify). I/We attach the documents required under Regulation 9 (3): Dated at …………………… this …………… day of ……………., 20 ….. Signature(s) ………………………. Applicant(s) FORM NO. CR 6 (r.10 (2)) THE COPYRIGHT ACT, 2001 THE KENYA COPYRIGHT BOARD APPLICATION FOR VERIFICATION OF THE ASSIGNMENT OF A COPYRIGHT WORK UNDER SECTION 33 (3) OF THE ACT Name and address of the applicant(s) Physical address of the applicant(s) Name and address of agent (if any) Category of copyright work Copyright registration number, applicable Application number Name and address of former owner(s) Name and address of new owner(s) I/We, the applicant(s) identified above, hereby apply for verification of the above copyright work under section 33 (3) of the Act.