Copyright Application Form

This form lets an author or rights holder submit the details of a work in order to apply for copyright registration with the relevant authority.

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Name of Copyright Owner

Nombre

Apellido

Address of Copyright Owner

Dirección

Ciudad

Estado / Provincia

Código postal

Name of Author

Nombre

Apellido

Country of Citizenship of Author

Alien Certificate Number (if foreigner)

Job Title of Author

Classification of Work

If Modification Of a Previously Registered Copyright Work, State the New Matter

Date Completed

Date First Printed/Reproduced

City of Printing/Reproduction

Name of Publishing Company

Your capacity in this copyright application

Author Owner Authorized Representative Other

I certify that the information provided above is true and correct.

Name

Nombre

Apellido

Signature

Sign here

Date

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