REGISTRATION OF WORKS FORM COMPOSER / AUTHOR (Name and Surname as per ID) Identity Number / Passport Number / Company Registration Number PUBLISHER (Where Applicable) Company Registration Number Registration Type Composer / Author Publisher Catalogue Sub-Publisher Contact Number(s) E-mail Address
I, THE UNDERSIGNED, DECLARE, ACKNOWLEDGE AND CONFIRM THE FOLLOWING: 1. I AUTHORED/COMPOSED AND/OR PUBLISHED ALL WORKS MENTIONED HEREUNDER. 2. I HAVE, BY MEANS OF A SEPARATE DEED OF ASSIGNMENT, ASSIGNED TO SAMRO MY PERFORMING, AND/OR FILM SYNCHRONISATION RIGHTS IN THE SAID WORK(S). 3. I HEREBY ALSO LIST ALL AUTHORS/COMPOSERS AND/OR PUBLISHERS ELIGIBLE TO REGISTER AS AUTHOR/COMPOSER AND/OR PUBLISHER. 4. SAMRO SHALL NOT BE HELD LIABLE FOR ANY CLAIMS OF ANY KIND ARISING FROM DISPUTES AND ACTIONS RELATING TO MY INVOLVEMENT IN THE WORKS INDICATED HEREUNDER. Date Signature Composer / Author Publisher The person notifying is required to send to SAMRO, together with this form, a copy of his/her Deed of Assignment and or Exclusive Song Writers Agreements with the publisher ONLY in cases where an agreement exists. Copies of contracts with film-producers should also be sent to SAMRO. To obviate unnecessary duplication of administration, kindly keep a copy of all notifications sent to SAMRO. 1. Title Alternative Title
2. Title Alternative Title 3. Title Alternative Title
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30. Title Alternative Title 1. TITLE OF WORK: The original / official title of the musical work.
2. ALTERNATIVE TITLE(S): If the work has alternative title(s) or commonly used title(s) please furnish these in the block. 3. DURATION: The actual duration of the musical work in minutes and seconds. 4. PERFORMING ARTIS(S) / GROUP: Please supply surname and name of performing artist in case where music was written for a specific artist or group. 5. CAPACITY / ROLE CODE: A Author AD Adaptor AR Arranger C Composer E Publisher SA Sub-Author SE Sub-Publisher 6. PR %: Performing Rights Share Percentage. SAMRO IS AFFILIATED TO THE INTERNATIONAL CONFEDERATION OF COPYRIGHT SOCIETIES: CISAC SAMRO Place, 20 De Korte Street, Braamfontein, Johannesburg, Gauteng. P.O. Box 31609 Braamfontein, 2017 TEL: (011) 712 8000. FAX: +27(0)86 674 4391 E-mail: customerservices@samro.org.za (Reg. No. 1961/002506/08)