LICENSE APPLICATION FORM (Restaurants Bars Cafes Lounges/Offices, Banks, Industrial Premises, Supermarkets, Stores)

SECTION A - GENERAL INFORMATION

Please select as appropriate *

Restaurants, Bars, Cafes, Lounges
Offices, Banks, Industrial Premises, Supermarkets, Stores
Clubs, Discos, Lounges
Petrol Stations, Premises/Similar Establishments

Contact Person *

Business Trading Name

Name of Proprietor *

Please state company name if applicable

Business Address *

Address Line 1

City

State / Province / Region

Country

Email *

Telephone # 1 *

Telephone # 2

SECTION B – BACKGROUND MUSIC

If recorded music is played in other parts of the premises such as in Lounges or played in other business owned/operated by same proprietor

Locations

A Location:

Name of Establishment/Branch/Section/Outlet *

Commencement Date *

Size in Square Feet *

Total Area of Premises Where Background Music is Used (Sq/Feet)

Avg. Attendance Per Day

Type of Establishment *

e.g Café, Bar - Office, Bank, Industrial Premises, Supermarket, Store - Club, Disco, Lounge etc.

Seating/Person Capacity *

Type of Equipment Used to Play Sound Recordings *

CD Player
Cassette Deck/Turntable
Traditional Radio
Television/Video Screens
Satellite Radio
Digital Memory Music
Other

Tick applicable box/es

Number of Television/Video Screens *

Other Type of Equipment *

SECTION C – SPECIALLY FEATURED ENTERTAINMENT

Occasional Events and Regular Events

Occasional Events – One-Off and Sseasonal Events
Regular Events – Nightly Club Sessions

OCCASIONAL EVENTS – ONE-OFF AND SEASONAL EVENTS ETC

Occasional Events

Occasional events – One-Off and Seasonal Events etc.

An Occasional Event:

Name of Event *

Type of Event *

e.g. Concert, Party, Product launch etc.

Hrs. of Record Use Per Event *

Entry Fee *

Date of Event *

Number of Events Per Year *

Avg. Attendance per event *

REGULAR EVENTS – NIGHTLY CLUB SESSIONS

Weekly Events

A Weekly Event:

Day of the Week *

Number of Hours of Record Use Per Occasion *

Average Entry Fee *

Number of Occasions Per Month *

Average Attendance Per Occasion *

Notes:

Specially Featured Entertainment – Where sound recordings are used as a main attraction but not necessarily the main attraction.
Hours of Record Use – The actual playing time during which sound recordings are played.
Average Attendance – This should include all person admitted to the area where sound recordings are being played as specially featured entertainment whether or not they have paid an admission fee or are members or guests.

SECTION D – FURTHER INFORMATION

Please provide details of any additional use of sound recordings not covered in Section B/C

Name of Authorized Officer *

Position of Authorized Officer *

By submitting this form you assert that the information entered here is accurate and true. *

By submitting this form you assert that the information entered here is accurate and true.

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