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.

Use this template

Name of Copyright Owner

First Name

Last Name

Address of Copyright Owner

Street Address

City

State / Province

ZIP / Postal Code

Name of Author

First Name

Last Name

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

First Name

Last Name

Signature

Sign here

Date

Related templates