Certificate of Registration

Registration Number:
Effective on:_______(date)

Title:_____________________
Title of work:_______________

Authors Name:_________________
Address:__________________
Completion/Publication____________________
Year of completion:____________________
Copyright claimant:_______________
Rights and permission_______________________
Organization name:
Address:
Amount in words:_________________________
Certification__________________________

Authorised Signature:
Dated:

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