CR3-Form

COPYRIGHT APPLICATION FOR AMENDMENT OF A WORK BEFORE AND AFTER REGISTRATION

Form No: CR3

N$100.00

Reference No: __________________

(Tick one): ☐ Individual  ☐ Company  ☐ Agent

A. Applicant Details:

Applicant Name(s):

Nationality

Certified Identification Documents

Residential Address

Address for Service (P.O. Box)

Phone

Email

B. Agent Details:

Applicant Name(s):

Nationality

Certified Identification Documents

Residential Address

Address for Service (P.O. Box)

Phone

Email

C. Title of the Copyright Work

Title: ________________________________________________________

The Applicant hereby applies for:

☐ Amendment of Work Before Registration

☐ Amendment of Work After Registration

Description of Amendment: (Please ensure the amended document is attached.)

Dated this ________ day of ____________________, 20________.

Signature of Applicant/Agent: _____________________________________

D. Declaration

I/We hereby certify that the content of this addendum is original, results from my/our own research or creative effort, and does not contain previously published material. I/We further declare that the work does not infringe on any existing copyrights, property rights, or licences of others, and is free from plagiarism. I/We understand that registration by BIPA does not constitute endorsement of the work, confirmation of authorship, or validation of business practices. I/We undertake to use the Certificate issued by BIPA only for lawful purposes and accept full responsibility for any misuse.

Signature: ___________________________________ Date: _______________________

Official Use Only

(Tick Documents Submitted):

☐ Application Form

☐ Certified Copies of Identification Documents (ID/Passport)

☐ Proof of Payment (e.g., Receipt)

☐ Certified Company Proof of Registration (if applicable)

Official Date Stamp: