Application File

SOCIALIST REPUBLIC OF VIETNAM

Independence - Freedom- Happiness

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PETITION FOR COPYRIGHT CERTIFICATE

To: THE COPYRIGHT OFFICE

1. Petitioner

Full name of petitioner

Is:

(Author; owner of work; heir; empowered person)

Date of birth: day                       month   year

Nationality:

Address:

Telephone number:                                 Fax number:

Hereby submits the application file for Copyright Certificate for:

 (If the person submitting the file is an empowered person, indications shall be required to make it clear that the file is submitted either on behalf of the author or on behalf of the owner of work)

2. Work to be registered

Title of work:

Genre of work:

(If the work is a translated, compiled, modified or transformed work,  clear indications shall be required as to  the name of the author of the original work and the title thereof)

Date of publication or statement of unpublished status:

Place of publication:

Form of publication (publication, performance,...):

Substantial content of the work:

(In case of a work of co-authorship, indications shall be required as to  the creation  of each author)

3. Author

Full name of author:

Pen name:

Date of birth: day                 month                     year

Nationality:

Address:

Telephone number:                                 Fax number

(In case more than one person create a work, indications shall be required to name all the co-authors)

4. Owner of work

 Name of the owner of work:

 Date of birth:     day            month       year

(If the owner is an organization, indications shall be required as to the date of, and the number of the decision on, its establishment)

Nationality:

Address:

Telephone number:                           Fax number

The basis on which the ownership right arises:

(Being the owner of work by creation; organization that commissioned the author; individual or organization that contracted the author; contract of copyright transfer; or heir)

I pledge the above-disclosed facts are truthful. I assume all the legal liability, should the provided information appears to be false.