L.f. 1962 28 COPYRIGHT REGULATIONS, 2010 FOURTH SCHEDULE APPLICATION FOR APPROVAL TO OPERATE A COLLECTIVE ADMINISTRATION SOCIETY (regulation 22) APPLICATION FORM I. Name ofthe Society ................................................................................................................ . 2. Is the society registered under the Companies Act, 1963 (Act 179). Yes (if the answer is Yes provide evidence of registration). 3. Give the location ofthe address of the society's registered office ...................................... . 4. What is the entire membership strength of the society? .................................. (provide evidence of membership indicating where members are domiciled and the nature and title of published works owned by them. 5. What type of right does the society intend to administer (Tick as appropriate) 6. 0 No D 0 D (i) Music (ii) Perfonners ciii) Audiovisual 0 (iv) Literary 0 (v) Others 0 We the undersigned hereby declare that the infonnation provided above is accurate to the best of our knowledge. i Signature Full Name Position ii. Signature