APPLICATION FOR COPYRIGHT

(Please read instructions carefully before filling blanks).

Date __________, 200____

The DIRECTOR, The National Library, Manila

Sir: I have the honor to apply for the copyright registration of the

(A) UNPUBLISHED (work named herein of which )

(B) PUBLISHED (work named herein of which)

(C) ______________ COMPLETE COPIES

(D) PHOTOGRAPHS
(E) A TITLE AND DESCRIPTION WITH THE REQUIRED PRINTS

is or are herewith deposited accompanied by the required affidavit in compliance with the
provisions of Presidential Decree No. 49. The amount of P8.30 for the registration,
publication and certificate fees and thirty centavos for the stamp to be affixed to the
certificate are also enclosed. The data required by the rules and regulations of that office
follow:

1. Name and address of copyright owner: ______________________________

(GIVE CLAIMANT’S FULL LEGAL NAME,
______________________________________________________________
& WRITE HIS STREET NUMBER, MUNICIPALITY & PROVINCE VERY CLEARLY & LEGIBLY)

2. Name of the author: _____________________________________________

3. Country of which the author is a citizen ______________________________;

(NAME OF COUNTRY MUST BE STATED)

4. If alien author, state Alien Certificate No. and where ciled in the Philippines:
______________________________________________________________

5. Title of the work: ________________________________________________

(GIVE THE TITLE EXACTLY AS IT APPEARS ON THE FRONT PART
______________________________________________________________
OR TITLE (PAGE OF THE WORK FOLLOWED BY THE EDITION NUMBER, IF ANY)

6. Class to which the work belongs: ___________________________________

7. If copyright is claimed upon new matter in a reissued work, state new matter
specifically:
(MENTION ADDITIONAL CHAPTERS BY NUMBERS FOLLOWED BY INCLUSIVE PAGES IN
PARENTHESIS – OTHER MORE OR LESS SHORT BUT MATERIAL ALTERATIONS AND ADDITIONS MAY
BE INDICATED BY MENTION OF PARAGRAPH OR PAGES)
____________________ and give registry number of next previous edition copyrighted;

8. (F) MADE, PRODUCED OR PERFORMED

(G) PRINTED OR REPRODUCED IN COPIES on the _________ day of _________,
(DATE WHEN THE WORK OR ITS
PRINTING WAS COMPLETED)

200__ at ___________________ by _________________________________________

(MUNICIPALITY/PROVINCE) (NAME OF PERSON/ ESTABLISHMENT MAKING THE
PRINTING/ REPRODUCTION IN COPIES)

9. First published or sold to the public in the Philippines on the

______________________________________________________________
(STATE DAY THE WORK WAS PLACED ON SALE, SOLD, OR PUBLICLY DISTRIBUTED)

day of ________________________, 200___, at _________________________

(MUNICIPALITY/PROVINCE)
by ______________________________________________________________
(NAME OF PERSON AND ESTABLISHMENT)

10. Send certificate of registration to: __________________________________

(WRITE THE NAME AND ADDRESSLEGIBLY)

11. Unit price if reproduced in copies for sale: P _____________________

Very respectfully,

________________________
(Signature of Applicant)

AFFIDAVIT

(IMPORTANT – This affidavit must be executed by individual – an official of a

corporation or firm may act – and must be under the seal of an officer authorized to
administer oaths within the Philippines. In case of published works, the execution must
be subsequent to the date of publication. The affiant must fill in the required statements
to accord with the facts concerning the work named, and draw pen through statements not
intended to be made.)

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF _______________ ) SS
MUNICIPALITY OF ___________ )

I, _____________, {BEING DULY SWORN, DEPOSE DO SOLEMLY AFFIRM} and say:

(A) PERSON CLAIMING COPYRIGHT IN

(B) PRINTER WHO PRINTED
(C) DULY AUTHORIZED AGENT OR
That I am the REPRESENTATIVE RESIDING IN THE the work named therein;
PHILIPPINES OF THE CLAIMANT OF
 COPYRIGHT IN

(D) I AM ACTUALLY A RESIDENT OF THE MUNICIPALITY OF ________________,

PROVINCE OF _______________, AND

that (E) ____________________________________________ OF _________________________

(NAME OF CLAIMANT IF OTHER THAN AFFIANT) (MUNICIPALITY, PROVINCE)

claim ownership of (F) AS

copyright in the (G) BY ASSIGNMENT FROM the author thereof; that the
said work (H) BY INHERITANCE FROM

(I) COMPLETE COPIES

(J) PHOTOGRAPHS
said work of which have been deposited,
(K) A TITLE AND DESCRIPTION
is entitled
WITH THE REQUIRED PRINTS
______________________________________________________________________
(GIVE THE TITLE EXACTLY AS IT APPEARS ON THE FRONT PART OR TITLE PAGE OF THE
WORK. FOLLOW IT BY EDITION NUMBER IF ANY, THEN BY AUTHOR’S NAME IF HE IS
DIFFERENT FROM CLAIMANT)

and has (L) MADE, PRODUCED OR PERFORMED at ______________________

been printed (M) PRINTED OR REPRODUCED IN COPIES (MUNICIPALITY,PROVINCE)

by _______________________________; the work or its printing or reproduction having

(NAME OF PERSON OR ESTABLISHMENT)
been completed on the _____________ day of _______________, 200__; and that the
said work was first published or sold to the public in the Philippines on the
_______________________________________________ day of __________, 200__ at
(MUST AGREE WITH THE DATE GIVEN IN THE APPLICATION)
__________________________ by ___________________________________________
(MUNICIPALITY, PROVINCE) (NAME OF PERSON OR ESTABLISHMENT)

__________________________________________
(Signature of person making affidavit)

Subscribed and sworn to or affirmed before me this _________ day of

______________, 200__. The deponent in the foregoing affidavit exhibited to me his
Residence Certificate No. _____________ issued at the Municipality of ____________,
Province of ________________ Philippines, on _______________, 200___.

TIN NO. ___________________________

___________________________________
NOTARY PUBLIC
My commission expires on Dec. 31, 200__

Doc. No. ___________;

Page No. ___________;
Book No. ___________;
Series of 200__.