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FORM-II
Hkkjr esa vk;kr dh xbZ fQYe ds lkoZtfud izn’kZu ds izek.ku ds fy, vkosnu dk iz:i |
( mifu;e (1
1) fu;e 21 dks ns[ksa )
Form of application for certification for public exhibition of a film imported into India
( See sub-rule (1) of rule 21 )

vkosnu la[;k ,oa fnukad ( cksMZ dk;kZy; }kjk Hkjk tk,xk )

No. and Date of application ( to be entered by Board's office )

lsok esa]€
dsUnzh; fQYe izek.ku cksMZsa
}kjk izknsf’kd vf/kdkjh€
€
To,
The Central Board of Film Certification
through the Regional Officer at

izFke ckj Hkkjr esa vk;kr dh xbZ fQYe ds yksd izn’kZu ds izek.ku ds fy, vkosnu i= |
Application for Certification for public exhibition of a film first imported into India at :

1-€ d- fQYe dk uke

(a) Name of the film :

€€ [k- fQYe dh Hkk"kk

(b) Language of the film :

x- QqVksa@ ehVjksa esa fQYe dh yackbZ € -------------------------------------lh-lh-ih vkSj@;k vk;kr vuqKfIr esa ;Fkknf’kZr fQYe dh
yackbZ D;k vkosnd }kjk LoSfPNd :i ls dksbZ dkV&NkaV dh xbZ gS vkSj ;fn dh xbZ gS rks mldk C;kSjk nhft, A
(c) Length of the film : feet meters.
Length of the film as shown in CCP and/or import license.: feet meters.
Have any cuts been made voluntarily by the applicant and if so give details.:

€€ ?k- jhyksa dh la[;k

(d) Number of Reels :

€€ p- fQYe dk xst
(e) Gauge of the film :

€ €N- fQYe dk izdkj % tSls 2&Mh]] 3&Mh]] flusekLdksi ;k foLVkfot+u gS |

(f) Type of the film i.e whether it is 2D, 3D, Cinemascope, vistavision etc. :

€€ t- D;k fQYe ewd gS ;k lokd

(g) Whether the film is silent or talkie :

€€ >- fQYe dk jax

(h) Colour of the film :

€€ V- fuekZrk dk uke
(i) Name of the Producer :

€€ B- funsZ'kd dk uke
(j) Name of the Director :
€€ M- fdl ns’k esa fufeZr dh xbZA
(k) Country in which produced :

2- mYys[k dhft,] fQYe lekpkj fp=@o`Rrfp=@oSKkfud@'kS{kf.kd@ Qhpj@foKkiu fQYe gSA

2. State whether the film is a newsreel/ documentary/ scientific/ educational/ feature/ advertisement film :

3- fQYe ds usxsfVo ,oa ikstsVho fizaVksa dh la[;k vyx&vyx nsaA

3. State separately the number of negative and positive prints of the film.

€ d- vkosnd }kjk vk;kr dh xbZ€(usxsfVo€€€€€€€ €€€€ ikstsfVo€€€€€€)

(a) Imported by the applicant ( negative positive )

€ [k- vkosnd ds vf/kiR; esa€€€€€€€ ( usxsfVo€€€€€€€ € ikstsfVo€€€€€ )

(b) In the applicant's possession ( negative positive )

4- ;g fQYe fdu fdu vU; Hkk"kk@Hkk"kkvksa esa ;fn gks@gksa fufeZr ;k Mc dh xbZ gS\ tgkaizR;sd Hkk"kk esa 'khZZ"kZd ,d ugha gS
ogka fQYe ftl &ftl Hkk"kk esa fufeZr Fkk Mc dh xbZ gS mlesa mldk 'kh"kZd fy[ksa A
4. In what other language/languages, if any, has this been produced or dubbed? Where title is not the same in each
language, state the title of each version in which it has been produced or dubbed.

5- bl fQYe dks izekf.kr djus ds igys Hkh vkosnu fd;k x;k gS orZeku o vU; 'kh"kZd ds vUrxZr
d- Hkkjr esa]€€ [k- la;qDr jk"V~z vesfjdk esa]€€€ x- ;wukbVM fdaxMe esa]€€ ?k- fdlh vU; ns’k esa]€;fn ,slk gS rks]
5. Has any previous application been made to certify this film ( under its present or any other title) in
a) India, b) United States of America, c) United Kingdom, d) Any other country. :
If so,
(i) dgka vkSj fdls fn;k x;k \
(i) Where and to whom was it made?

(ii) vkosnu dk ifj.kke D;k Fkk \

(ii) What was the result of the application ?
€€€€ 1. ;w@;w,@,@,l izek.ki= la[;k -------------------------------------fnukad ------------------ fn;k x;kA fuEu dkaVNkaV ds 'krksaZ ij
1. 'U'/'UA'/'A'/'S' _____________ Certificate No. __________ dated __________ was granted to the following cuts.

€€€€ 2- izek.ki= nsus ls bUdkj dj fn;k x;k FkkA€

2. Certificate was refused?

la;qDr jk"V~z vesfjdk esa fufeZr fQYe dh n’kk esa mldk jsfVax
In the case of film made in the United States of America state the rating of this film according to

€€€€€€€€€ d- jk"V~zh; lewg vkSj

(a) the national groups :

€€€€€€€€€ [k- f’k"Vrk dh e;kZnk ds vuqlkj fyfi

(b) the legion of decency. :

6- D;k dHkh fQYe ds yksd izn'kZu ij jksd yxkbZ x;h vFkok dsUnzh; o fdlh jkT; ljdkjksa }kjk vizekf.kr ?kksf"kr fd;k
x;k \ iw.kZ fooj.k nsaA
6. Has the exhibition of this film been at any time suspended or the film declared uncertified by the Central or any State
Government? State Particulars.
7- D;k fQYe esa vaxzsth vFkok Hkkjrh; Hkk"kkvksa ds vykok fdlh vU; Hkk"kk esa laokn] xkuk] dfork] Hkk"k.k o dkWesUV~zh gS \
7. Does the film contain any dialogue, song, poem, speech or commentary in any language other than English or any
Indian language?

€ ;fn ,slk gS rks jhy ;k jhyksa dks mYys[k dhft, ftlesa xkuk] dfork] Hkk"k.k] laokn o dkWfeUV~zh vkrk gS vkSj iz;ksx dh
xbZ Hkk"kk gS A
If so, specify that reel or reels in which the dialogue, song, poem, speech or commentary and the language or
languages used.

(d) ;fn fQYe dkYifud ;k lR; ?kVuk ;k okLrfod dgkuh ;k ikSjkf.kd ;k egkdkO; ;k nSfod ;k thouh ij
vk/kkfjr gS rks mldk lzksr D;k gS A
(a) Specify whether the film is based on fiction or true incident or true story or mythology or epic or devotional or
biographical and if so the source from which it has been made may be mentioned :

8- fu;e 36 ds vUrxZr vkosnu ds lkFk fn;k x;k 'kqYd dk jde

8. Amount of fee accompanying the application on account of the fee prescribed in Rule 36.: Rs. cesnor + scr fee
Amount

(i) jlhn la ------------------------------------------- fnukad -----------------------------------

(i) Receipt No. Receipt No. Dated Date

(ii) cSad M~zkQ~V la[;k -------------------------------- fnukad ------------------------------

(ii) Bank Draft No. _________ Date __________ on Bank _________ .

(iii) iksLVy vkWMj la[;k -------------------------------Mkd?kj------------------fnukad ------------------------------

(iii) P.O. No. _________ Post Office __________ dated __________.

9- D;k fQYe ds 'kwfVax esa fdlh i'kq dk mi;ksx fd;k x;k gS \ ;fn gks rks D;k fu;e (21) ds mifu;e (3) ds [kaM ([k
[k) esa fofufnZ"V ?kks"k.kk Qkby dj nh xbZ gS \
9. Whether any animal has been used in shooting the film? If so, whether declaration specified in clause (bb) of sub-rule
(3) of rule (21) has been filed?

10- vkosnd dk uke]irk rFkk nwjHkk"kk ua] ;fn gS rksA

10. Name, address and telephone number, if any of the applicant

11- d- fQYe ds vk;krdrkZ dk uke]irk vkSj VsfyQksu ua ] ;fn dksbZ gS

11. (a) Name, address and telephone number, if any, of the importer of the film

€€ [k- vk;kr&vuqKfIr dk la[;k vkSj rkjh[k

(b) Number and date of the import licence :

€€ x- lhek’kqYd dk;kZy; ls fudklh dh rkjh[k

(c) Date of clearance through the customs :

12- D;k fQYe nf{k.kh vkfQzdh ;k jksMsf’k;k;h jk"V~zksa }kjk ;k ds lg;ksx ls iw.kZr;k ;k va’kr% nf{k.k vkfQzdh] nf{k.k
if’peh vkfQzdh ;k jksMsf’k;k esa fufeZr dh xbZ gS ;k fQYe nf{k.k vkfQzdh ;k jksMsf’k;kbZ jk"V~zksa ds iw.kZr% ;k va’kr%
LokfeRok/khu gS \ ;fn gS rks fooj.k fyf[k, A
12. Has the film been produced by or in collaboration with South African or Rhodesian nationals wholly or in part in South
Africa, South West Africa or Rhodesia or in the film owned wholly, or in part, by South African or Rhodesian nationals? If
so, give details.
13- eSa ?kksf"kr djrk gwW fd cksMZ }kjk ijh{k.k djus ds fy, fizaV rS;kj gS vkSj mij fy[ks x, fooj.k lR; gSA
13. I declare that the print of the film is ready for examination by the Board and the statements recorded above are true in
every particular.

LFkku
Place : vkosnd dk gLrk{kj
fnukad Signature of the applicant
Date : Name & Designation