PARTC APPLICATION FOR REGISTRATION OF A LICENCE CNRFORM3 .Section(s)-49 of Act Section(s) 11 of Re8ulatioos FOR OFFICIAL USE Received on: ..................•.............. APPLICATION FOR REGiSTRATION OF AUCEN~E . IN TERMS OF SECTION 49 OF TIm ACT RegistIlr of Copyript and Neijhbouring Rights HARARE Licensee'siAgent ref: ....... . TO: 1. In the matter of application for registration of a licence in terms of section 49 of tbeAct Registration No: .................................... . F'I!ing date: ..................................~ ... TItle of work: ................, ....................... . RegiStration date: ............................. Category of work: ....................~ .............................,............. _ ................................. 2. OwoerslLicensee Name: .................................. ¥ .........._ ........................................ .. Address: .................................................................................................................. . .................................................................................! ......... h~ . . . . . . . . . . . . . . . . . . . . . . . . ·.u l' 3. Licensee's Name: ...................................... Nationality: ....................,................ Address: ................:.................:........................;......................................................: DomicileJPrincipal place ofbusiness: ..................................................................... .. 4. APPUCATION . <a> The above-identified ownenllicensor bereby join, in applicaliol'l with the lic:cnsce 110 that the liCence may be reail~ in _pect of the obove-identiticd copyrigbt subject to the folJowiDl conditions or reslrictions. 5. (b) 1be~tamO(lK:aIcecodson ................. .dayof .........~..... .Jiswilboutlimitofperiod. (c) The 1k:euc:O wiJllwiU not be on exclusive licence. nrus DONEANDSIGNSDAT.................this ...............dayof:............2O'............. .. Address for service: ......................... :........... • • • • • • • • • • • • • • • • • • • •.J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AppIk:ant(s)lAgent for applli;ant(s)