STATUTORY DECLARATION

I, NAME , (IC NO), of full age and a Malaysian citizen with an address at ADDRESS
sincerely and solemnly declare the following:

1. Title of literary work: TITLE (hereinafter referred to as the ‘work’);

2. The owner of the copyright in the works: OWNER NAME (E.G: COMPANY

NAME)

3. The authors of the works are as follows:

i. NAME (IC NO)

4. The work has been written down and reduced to material form on DATE OF
FIXATION.

5. Annexed hereto and marked as Exhibit “A” for the purpose of notification of
copyright in Form CR-1 is the copy of the work.

6. I make this declaration in accordance to Section 26A(3)(b) of the Copyright Act

1987.

and I make this solemn declaration conscientiously believing the same to be true, and by
virtue of the Statutory Declarations Act 1960.

Subscribed and solemnly declared by the abovenamed

NAME (IC NO)
At (CITY) in the State of (STATE)
this day of 02/01/2013

Before me,
…………………………………………
(Signature of Sessions Court Judge,
Magistrate, Commissioner for Oaths
or notary public)
 .

The following is an Exhibit marked as “A” referred to in the Statutory Declaration (NAME)
(NRIC No) affirmed before me on

Before me,

…………………………………………
(Signature of Sessions Court Judge,
Magistrate, Commissioner for Oaths
or notary public)