Copyright Registration Statement of Particulars -- Template

                         STATEMENT OF PARTICULARS
        (To accompany the application for registration of copyright —
         Form XIV under Rule 70, Copyright Rules, 2013; Section 45 of
         the Copyright Act, 1957)

Diary No. / Application No.: [to be allotted by Copyright Office]
Date: [DD-MM-YYYY]

 1. Name, address and nationality of the applicant:
    [Name], [Full Address], [Indian].

 2. Nature of the applicant's interest in the copyright of the work:
    [Author / Owner / Assignee / Licensee / Publisher].

 3. Class and description of the work:
    Class: [Literary (other than computer programme) / Computer
    Software / Artistic / Musical / Sound Recording / Cinematograph
    Film]; Description: [brief description of the work].

 4. Title of the work:
    "[Title of Work]".

 5. Language of the work:
    [English / Hindi / ___].

 6. Name, address and nationality of the author, and if the author is
    deceased, the date of his decease:
    [Author Name], [Address], [Indian]; [alive / date of decease ___].

 7. Whether the work is published or unpublished:
    [Published / Unpublished].

 8. Year and country of first publication, and name, address and
    nationality of the publisher (if published):
    Year: [Year]; Country: [India]; Publisher: [Name & Address].

 9. Years and countries of subsequent publications, if any, and names,
    addresses and nationalities of the publishers:
    [Details / Not applicable].

10. Names, addresses and nationalities of the owners of the various
    rights comprising the copyright in the work and the extent of rights
    held by each, together with particulars of assignments and licences,
    if any:
    [Owner Name], [Address], [Indian] — holds [all rights / specified
    rights]; Assignment/Licence particulars: [details / Nil].

11. Names, addresses and nationalities of other persons, if any,
    authorised to assign or license the rights comprising the copyright:
    [Details / Nil].

12. If the work is an "Artistic work", the location of the original
    work, including name, address and nationality of the person in
    possession of it. (For an artistic work used or capable of being
    used in relation to any goods or services, also state whether it is
    registered under the Trade Marks Act, 1999, and a certificate under
    Section 45(1) proviso from the Registrar of Trade Marks):
    Location of original: [Address]; Trade-mark registration: [No / TM
    No. ___]; NOC / search certificate enclosed: [Yes / No].

13. Remarks (if any):
    [___].

I / We hereby declare that to the best of my/our knowledge and belief no
person, other than as mentioned in the columns above, has any share or
interest in the copyright in the said work.

Place: [City]
Date : [DD-MM-YYYY]
                                                ____________________
                                                Signature of Applicant
                                                [Name]

VERIFICATION:
I, [Name], the applicant above named, do hereby verify that the contents
of the above Statement of Particulars are true to the best of my
knowledge and belief.

Verified at [City] on this [Day] day of [Month, Year].
                                                ____________________
                                                Signature of Applicant

Enclosures:
 (a) Copies of the work (2 copies for published; 1 copy of manuscript /
     source code for unpublished — first & last 10 pages of code).
 (b) No-Objection Certificate(s) from author / publisher / other
     copyright owners, as applicable.
 (c) Power of Attorney (if filed through an advocate/agent) — Form
     XIV requires the agent's authority.
 (d) For artistic work used as a trademark: search certificate / NOC
     from the Trade Marks Registry.
 (e) Statement of Further Particulars (for literary/artistic works).