UGANDA REGISTRATION SERVICES BUREAU THE COPYRIGHT AND NEIGHBOURING RIGHTS REGULATIONS, 2010 FORM 11 APPLICATION FOR CLEARANCE OF IMPORTED AUDIO VISUAL RECORDINGS FROM OWNER OR COLLECTING SOCIETY To: …………………………………………………..(Name of Collecting society) of ……………………………………… (Address of society) 1. Name of applicant/ importer…………………………………………….. 2. TIN No………………………………………………………………….. 3. Address………………………………………………………………….. 4. Physical Address ……………………………………………………… 5. Tel No…………………. Fax………………. E-mail………………….. 6. Title of work for which clearance is sought………………………….. 7. Type of work: Audio* Audio visual* Tick whichever is applicable 8. Quantity of material being imported……………………………………. 9. Name of author(s) ……………………………………………………. 10. Name and address of producer…………………………………………. 11. Has the importer received authorization of the producer or his or her authorized representative to import the said work? Yes* No* 12. Declaration: I/We……………………………………………………………………… … declare that the information given above is true to the best of my/ our knowledge and that any misinformation provided by me/ us shall render my/our application void. Date…………………………………………………… Signed…………………………………………………………. Official stamp/ seal, where applicable. Note: Importers must ensure that the imported materials are authenticated by the society of origin or by the copyright holder. To be filled in triplicate; Original to Society; copy to customs; copy to importer To be completed for every title imported. 22