Form D Regulation 12 COPYRIGHT ACT (CAP 51) Certificate of Registration The following work, namely.............................................................................. ......................... has been entered in the Register under Reference No. ...............................................................................in the name of .......................................................................................................................... as of the .................................................................................................. , 19...... sealed at my direction this........... .................................. ... ................................ ...........................................day of ........................................................ , 19........ .Registrar The Registrar of Copyrights Office, Victoria NOTE: Upon any change of ownership of this copyright, or change in address, the Registrar should be advised AT ONCE. __