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Canadian Intellectual Property Office Symbol of the Government of Canada


Application for Registration of a
Copyright in Other Subject-matter

[ Français ]


For assistance in completing the form, please refer to the "Instructions" sheet. Please print.

1. Title of the subject-matter (if any)

2. Subject-matter
Date
Type Y    M    D
  A. Performer's performance     1st Fixation     1st Performance__   __   __
  B. Sound recording - 1st Fixation__   __   __
  C. Communication signal - 1st Broadcast __   __   __


3. Owner(s)
A. Family name: ____________________ Initial: __ First name: __________________

B. Name of corporation or firm (if applicable): ___________________________________

C. Address:
c/o: ____________________________________________________

Street: __________________________________________________

City/ Town: _________________

Prov./ State: ____________________

Country: ___________________

Postal/ ZIP code: ________________

Telephone: _________________

Facsimile: _____________________

E-mail: ____________________



4. Declaration

I/ We hereby declare that the applicant is:

The owner of the copyright in the subject-matter
An assignee of the copyright in the subject-matter
A licensee of the copyright in the subject-matter


5. Agent (if any)
The applicant is the same as owner in section 3, or

A. Family name: ____________________ Initial: __ First name: __________________

B. Name of corporation or firm (if applicable): ___________________________________

C. Address:
c/o: ____________________________________________________

Street: __________________________________________________

City/ Town: _________________

Prov./ State: ____________________

Country: ___________________

Postal/ ZIP code: ________________

Telephone: _________________

Facsimile: _____________________

E-mail: ____________________



(For Canadian Intellectual Property Office use only)


All correspondence should be addressed to:
Copyright Office
Canadian Intellectual Property Office
Industry Canada
Place du Portage I
50 Victoria Street
Gatineau, Quebec  K1A 0C9		   Telephone: (819) 997-1936
Facsimile: (819) 997-6357
Internet address: www.cipo.gc.ca
E-mail: cipo.contact@ic.gc.ca

Please do not send copies of your work.

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