Seal of the Board Signature ......................................... Executive Director, The Kenya Copyright Board. FORM NO. CR 8 (r. 12 (3)) THE COPYRIGHT ACT, 2001 THE KENYA COPYRIGHT BOARD APPLICATION FOR AUTHENTICATION OF A COPYRIGHT WORK UNDER SECTION 36 (1) OF THE ACT Name and address of the manufacturer/producer or sound recording or audio-visual work Physical address Name and address of agent (if any) Category of copyright work for which authentication is being sought Copyright application/registration number (if any) Number of copies to which this application relates I/We, the applicant(s) identified above, hereby apply for authentication of the above copyright work under section 36 (1) of the Act and I/we attach a certified copy of the contract allowing me/us to sell or distribute the said works. I/We declare that the information given above is true to the best of my/our information, knowledge or belief. BEFORE ME COMMISSIONER FOR OATHS NOTE: Authentication devices are not transferable. Dated at …………………… this ………… day of ……………., 20 …..