CR1-Form

APPLICATION FOR REGISTRATION OF COPYRIGHT

Form No: CR1

N$200.00

Reference No: __________________

(Tick one): ☐ Individual  ☐ Company  ☐ Agent

A. Applicant Details:

Applicant Name(s):

Nationality:

Identification Documents:

Residential Address:

Address for Service:

Phone:

Email:

B. Author (s) Details:

Applicant Name(s):

Nationality:

Identification Documents:

Residential Address:

Address for Service:

Phone:

Email:

C. Organisation/Company Details

Organisation/Company Registration Number

Registered Name

Date of Application (DD/MM/YYYY)

D. Agent Details:

Applicant Name(s):

Nationality:

Identification Documents:

Residential Address:

Address for Service:

Phone:

Email:

E. Copyright Work Details

Title of the Work: ____________________________________________

Category (tick where appropriate):

☐ Sound Recording

☐ Literary Work

☐ Audio-Visual Work

☐ Artistic Work

☐ Musical Work

Date of Fixation: DD ______ MM ______ YY ______

F. Production Details (if applicable)

Publication:  ☐ Yes  ☐ No

Date of First Publication: DD ______ MM ______ YY ______

City: ___________________________________

Region: _________________________________

Country: ________________________________

Place: __________________________________

ISBN Code (if applicable): ____________________

G. Abstract / Brief Description of the Work

(Attach additional pages if necessary.)

H. Declaration

I, _____________________________________, of P.O. Box _______________________, hereby certify that I have been adequately informed to make a decision regarding the registration of my copyright work. I understand and acknowledge that:

• Copyright protection extends only to the expression of ideas, not the underlying ideas, concepts, or slogans, which may be better protected by other intellectual property systems.

• Copyright registration is a voluntary notification system. Rights arise upon creation in accordance with established conventions, practices, and the Copyright and Neighbouring Rights Protection Act, No. 6 of 1994.

• Registration does not prevent others from independently creating and marketing similar works.

• In the case of infringement, I am responsible for initiating legal action, including any applicable criminal proceedings.

• Registration by the BIPA Copyright Office does not constitute endorsement of the work, validation of business practices, or confirmation of authorship.

• I undertake to use the certificate (Copyright Testimonial) issued by the Copyright Office only for lawful purposes and accept full responsibility for any unauthorized use.

On behalf of: __________________________________________ (Firm/Company/Ltd)

Signature: ___________________________________  Date: _____________________

Checklist of Attachments (For Official Use Only)

Please tick the documents submitted:

☐ Application Form

☐ Certified Copies of Identification Documents

☐ Proof of Payment (e.g., Receipt)

☐ Certified Company Proof of Registration (if applicable)

☐ Copy of the Work (e.g., Book, Manual, Poster, DVD, USB, CD, VCD)