PARTD APPLICATION FOR REGISTRATION OF A LICENCE OF RESERVED WORK,S OF FOLKLORE CNRFORM4 FOR OFFICIAL USE Section(s)-85 of Act Section(s) 13 of Regulations Received on: .............., .................. APPLICATION FOR REGISTRATION OF . A LICENCE IN TERMS OF SECTIOJ'J 85 OF THE ACT TO: Registrar of Copyright and Neighbouring Rights HARARE Licensee'slAgen! ref: ........ I. In the matter <if application for registration'of a licence in terins of section 85 of the Act Registration No: .......................,............ . Filing date: ..................... :.............. .. "ride of work: ......................... :.: ............ Registration date: ...........:................ . Category ofworic.: ......... :............................................................................:............ . 2. . OwnerslI...iceasee name: ....................................... :.; ........................ :............ :........... . Address: .. ,..................................... _...............: ........,: ............. :............................... .. ,'..................................................................................... :, ............................ . 3. Licensee's name: ................. :........ :......... .. Nationality: ................................... .. Address: ...................................................:..........................." ........ .............................. _. DomiciJelPrincipai place of b~siness: ....... :..... :........................................................ . 4. APPLICATION " (8) 'I1!e licensee(s), hereby applies(y} for the registration of the licence in respect of the above-identified reserved mark(s) of the folklore subject 10 the folJowil)g contition(s). (b) UWe are entitled 10 the reserved work of folldbre by virtue of: o D the accompanying licence. Any other document specify. 5. . THUSOONEANDSIGNEDAT.....": .......... this .... :..........dayof ............. 20...:........... . Address for service: ............ :....................... .. Applicant(s)/Agent for applicant(s)