Official Document

Copyright In-Take Form

Registration Application

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Basic Information

Date

Title of Work *

Any other alternative title?

Previously published?

Please check this box if the Work to be copyrighted was previously published as contributions to an article, periodical, etc.

Is the Work previously registered or has been applied for registration?

Yes

Purpose for registration

The work is the first publication edition of a previously registered work.

For copyright claim.

Amendments to the version of the work.

Author Information

Name of Author

Prefix

First Name *

Middle Name

Last Name *

Suffix

Citizenship of Author

Domicile of Author

Date of Birth

Deceased

Yes

Is this a work made for hire?

Yes

Nature of Authorship

Select one option:

Sculpture

Technical drawing

Photograph

Art Reproduction

Sound

Map

Dimensional artwork

Literary text

Jewelry design

Work Details

Date Created

Copyright Claimants

Claimant 1

Prefix

First Name

Middle Name

Last Name

Suffix

Address

Claimant Status

Author

Transfer

Additional Information

Applicant Information

Name of Applicant

First Name

Last Name

Signature

By typing your name above, you are electronically signing this document.

Disclaimer

I hereby certify that the information in this application and the statements made herein are true and correct to the best of my knowledge.

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