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FORM 4A
Regulation 21A
COPYRIGHT ACT
(CHAPTER 63)
COPYRIGHT TRIBUNAL (PROCEDURE) REGULATIONS
APPLICATION
To: The Secretary,
Case File No. ______________
Copyright Tribunal.
In the Matter of an Application under section 43 (3) of the Copyright Act by ______________________________________________________________________________
1. I ____________________________________of __________________________
(hereinafter called the Applicant), being –
*(a) the owner of the copyright subsisting in a literary, dramatic or musical work described in paragraph 2;
*(b) the maker of the *sound recording/cinematograph film described in paragraph 3,
hereby apply to the Copyright Tribunal under section 43 (3) of the Copyright Act for an order determining the amount that is equitable remuneration to _____________, the owner of the copyright subsisting in the work described in paragraph 2, for the making of a “sound recording/cinematograph film thereof solely for the purpose of broadcasting of the work or an adaptation thereof.
2.
The work to which this Application relates is as follows:
(1)
Title of Work_________________________________________________.
(2)
Description of Work ___________________________________________.
(3)
Full name of author or authors ___________________________________.
(4)
If the author, or any one or more of the authors is dead, name of deceased author or authors and date or dates of deaths ________________________.
(5)
Date and place of first publication of Work _________________________.
(6)
Status of author at the date of first publication _______________________.
*I am the owner of the copyright subsisting in the work (Give grounds for this statement): _______________________________________________________________.
3. The *sound recording/cinematograph film to which this Application relates is as follows:
(1) Title of *recording/film _________________________________________.
(2) Description of *recording/film ____________________________________.
(3) Full name of maker or makers of *recording/film ____________________.
(4) Status of maker or makers of the *recording/film ____________________.
(5) Date and place of making of the *recording/film _____________________.
*I am the maker of the *sound recording/cinematograph film (Give grounds for this statement): __________________________________________________________ .
4. The grounds of my Application are as follows:
(All details which may be relevant to the Application should be set out in a logical order and in numbered paragraphs. Copies of correspondence, etc., should not be attached but relevant particulars of or extracts from the correspondence should be quoted).
5.
The Applicant’s address for service is ___________________________________
________________________________________________________________________
Made this _______________ day of ________________ 20____.
Filing date
Signed *by/*on behalf of the Applicant.
(Mr/Mrs/Miss) ________________
Status of signatory if Application is signed on behalf of the Applicant.
_____________________________
*Delete whichever is inapplicable.
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