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FORM-2A
Hkkjr esa vk;kr dh xbZ ohfM;ks fQYeksa ds lkoZtfud izn’kZu ds izek.ku ds fy, vkosnu i=|
( mifu;e (1 1) fu;e 21 dks ns[ksa )
Form of application for certification for public exhibition of a Video 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 :

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

1-€ d- ohfM;ks fQYe dk uke

(a) Name of the video film :

€€ [k- ohfM;ks fQYe dh Hkk"kk

(b) Language of the video film :

€€ x- ohfM;ks fQYe dk pkyu le;

€€ lh-lh-ih vkSj@vFkok ykblsal esa fn[kk;k x;k ohfM;ks fQYe dk pkyu le;€€
(c) Running Time of the video film ( MM:SS):
Running time of the video film as shown in CCP or import license.:

€€€€ ;fn vkosnd us LoSfPNd dkV&NkaV izLrqr fd;k gS rks mldk C;kSjk nsa
Have any cuts made voluntarily by the applicant and if so give details.

€€ ?k- dSlsVksa dh la[;k

(d) Number of Cassettes :

€€ p- ohfM;ks esa ifjorZu djus dksbZ vU; fooj.k

(e) Any other particulars of the video conversion. :

€ €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 a of the Producer :
€€ B- funsZ'kd dk uke
(j) Name of the Director :

€€ n- fdl ns’k esa fuekZ.k fd;k x;k

(k) Country in which produced. :

2- mYys[k dhft, fd ohfM;ks fQYe lekpkj fp=@o`Rrfp=@oSKkfud@’kS{kf.kd@Qhpj@foKkiu ohfM;ks fQYe gSA

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

€ 2(v) vkxzg fd, x, izek.ki= dks funsZ'k dhft,% ;w] ;w,] ,] ,l

2(a) Specify the Certificate requested - 'U', 'UA', 'A' or 'S' :

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

3. State separately the number of negative and positive prints of the video 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 )

€ x- ysczksVjh @daiuh dk uke vkSj irk ij izfr;ka cuk;h x;hA

(c) Name and address of the processing laboratory / company where the copies were made :

4- (d)- ohfM;ks fQYe ftl ds fy, vkosnu fd;k x;k gS og mlh lsywykW;M pyfp= dh izfr:i@;FkkHkwr gS ftls dsUnzh;
fQYe izek.ku cksMZ }kjk izek.ki= fn;k tk pqdk gS A izekf.kr fQYe dk fooj.k Hkh nsaA
4. (a) Whether the video film for which the application has been made is a replica/exact copy of a cinematograph film on
celluloid in respect of which a certificate has already been granted by the Central Board of Film Certification. Also state
particulars of the film certified.

([k) D;k ohfM;ks fQYe lsywykW;M pyfp= dk la’kksf/kr :ikUrj.k dk fylesa tksM@fudky o vU; ifjorZu
gSA€:ikUrj.k dk iw.kZ fooj.k fn;k tk;A
(b) Whether the video film is a modified version of a certified Cinematograph film on celluloid containing additional
deletion/other alterations. Details of modifications may be provided.

(x) D;k vkosnu ftlds fy, fd;k tk jgk gS og ewy ohfM;ks fQYe gS ,oa iwoZ izekf.kr pyfp= dh izfr ugha gSA
(c) Whether the application being made is in respect of an original video film and not a copy of an already certified
cinematograph film on celluloid.

(?k) ;fn fdlh vU; Hkk"kk esa fuekZ.k@Mc fd;k x;k gS rks og dkSu lh Hkk"kk esa gSA fQYe dk 'kh"kZd izR;sd Hkk"kk esa ,d
ugha gS rks izR;sd fufeZr@Mc Hkk"kkarj.k dk 'kh"kZd dk mYysa[k djsaA
(d) In what other language/languages, if any has this been produced or dubbed? Where the title is not the same in
each language, state the title of each version in which it has been produced or dubbed.

5- bl ohfM;ks 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 video film/films ( Under its present or any other title) in
a) India, b) United States of America, c) United Kingdom, d) Any other country. :

If so,
 (d) dgka vkSj fdls fn;k x;k \
(a) Where and to whom was it made?

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

(b) 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= bUdkj fd;k x;kA

2. Certificate was refused?
;fn fQYe la;qDr jk"V~z vesfjdk esa cuh gS rks
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 dsUnz ljdkj }kjk ;k fdlh jkT; ljdkj }kjk yksd izn’kZu ij jksd yxkbZ x;h@fQYe dks € vizekf.kr ?
kksf"kr fd;k x;k \ iw.kZ fooj.k nsaA
6. Has the exhibition of this video film been at any time suspended or this video 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 video film contain any dialogue, song, poem, speech or commentary in any language other than English or in
Indian language? + Y or N +

€ ;fn gS rks dSlsV@dSlsVksa dk mYys[k dhft, ftlesa laokn] xkuk] dfork] Hkk"k.k o dkWfeUV~zh vkrk gS A
If so, specify that cassette or cassettes in which the dialogue, song, poem, speech or commentary and the language or
languages used.

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? + Y or N +

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- 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 ykblsal dk la[;k vkSj rkjh[k

(b) Number and date of the import licence : and

€€€ x- dLVe ls lek’kkf/ku dk fnukad

(c) Date of clearance through the customs :

12- D;k ohfM;ks fQYe iw.kZ ;k vkaf’kd :i esa nf{k.k vkfQzdk] nf{k.k if’pe vkfQzdk o jksMsf’k;k ds lg;ksx ls cuk;k
x;k ;k iw.kZ ;k vakf’kd :i esa nf{k.k vkfQzdk]o jksMsf’k;k ukxfjd ds LokfeRo esa gS \ 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 iw.kZ fooj.k nhft, A
12. Has the video film been produced by or in collaboration with South African or Rhodesian national wholly or in part in
South Africa, South West Africa or Rhodesia or is 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, ohfM;ks fQYe rS;kj gS vkSj mij fn, x, lHkh fooj.k lR; gSA
eSa ;g Hkh ?kksf"kr djrk gwW fd lacaf/kr ohfM;ks dk vf/kdkj esjs ikl gSA eSa iwu% ?kksf"kr djrk gwW fd Qhpj fQYe ds fo’ks"k
lkexzh V~zsyj] y?kq foKkiu] o`Rrfp= dk O;ogkj djus dk vf/kdkj Hkh esjs ikl gSA
13. I declare that the video film is ready for examination by the Board and the statements recorded above are true in
every particular. I also declare that I own the rights of the video film in question. I further declare that I have the right to
use in the video film the additional material in the feature film in the form of trailers, advertisements shorts, documentary
films etc.

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