CR4-Form

The form is always available to download and submit on paper.

Form No: CR4

N$10.00

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

B. Agent Details:

Applicant Name(s):

Nationality

Certified Identification Documents

Residential Address

Address for Service (P.O. Box)

Phone

C. Title of the Copyright Work

Title: ________________________________________________________

D. The applicant(s) hereby apply for the following:

☐ Copy of extracts from the register

☐ Consultation of the register

E. Reason(s) for Consultation

(Please provide a brief explanation)

Dated this ________ day of ____________________, 20________.

Signature of Applicant/Agent: _____________________________________

Checklist of Attachments (For Official Use Only)

(Tick Documents Submitted):

☐ Application Form

☐ Certified Copies of Identification Documents

☐ Proof of Payment (e.g., Receipt)

☐ Certified Proof of Registration of Company (if applicable)

Official Date Stamp: