Professional Documents
Culture Documents
COPYRIGHT
REGISTRATION AND
DEPOSIT FORM
Instructions:
1. Fill up completely. If an item is not applicable to you, please write
N/A.
2. Attach all relevant documents, including but not limited to: Deed of Assignment, Birth Certificate (for children), Marriage
Certificate (for spouses), Special Power of Attorney (for agents)
3. This form is not for sale and MAY BE reproduced.
4. Copyright registration and deposit is required by law for the sole purpose of completing the records of the National
Library (Section 191 of Republic Act No. 8293).
NATURE OF WORK
Title
(name given to a specific
work)
Type of Work
(book, musical composition,
etc.; see works included in
No. 6 of Guidelines for
Copyright Registration &
Deposit)
Date of Creation
(day the work was finished)
Nature of Applicant
Name
name of a natural person,
or a juridical person such as a
corporation or partnership, or
an organization)
Address
(address where the Certificate
of Copyright Registration and
Deposit shall be sent)
Sex
Citizenship
(nationality)
Date of Birth / Incorporation
(for juridical persons, date of
registration)
Civil Status
Telephone No.
Fax No.
Place of Creation
(place the work was done)
COPYRIGHT OWNERS DETAILS
Author / Creator (natural person who made the work)
Heir (spouse, child, or person named as heir in a will)
Assignee (person to whom the right was assigned)
Employer (person employing an author who made the work as a result of regularly-assigned
duties)
(full
Surname
First Name
Street Address
Barangay
State/Province
Male
Female
Country
Middle Name
City/Municipality
Zip Code
Passport No.
(for non-Filipinos)
First Name
Middle Name
Address
Sex
Citizenship
Date of Birth
Street Address
Barangay
State/Province
Male
Female
Country
Civil Status
Telephone No.
Fax No.
City/Municipality
Passport No.
Date of Death
(If applicable)
Single
Married
Mobile Phone No.
Email Address
I declare that all the information provided above are true to the best of my knowledge.
____________________________
Signature over printed name
Zip Code
(Name)
residing at
, of legal age,
(Nationality)
(Civil Status)
__
(Full Address)
after having been sworn in accordance with law, hereby depose and state that:
1. At the date and time of the execution of this affidavit, copyright subsists in the original work with the
following details:
Title of Work
Date Created
Place Created
Type of Work
Author(s)
Citizenship
Copyright Owner
:
:
:
:
:
:
:
:
:
2. I am the copyright owner/ one of the copyright owners/ representative of the copyright owner/s of the
work described above;
3. I have caused the registration and deposit of the said abovementioned work with the National Library of
the Philippines in accordance with 191 of Republic Act No. 8293 for the purpose of completing the
librarys records;
4. I am executing this affidavit and attaching a true copy of the work described above in order to constitute
affidavit evidence in accordance with Sec. 218 of the Intellectual Property Code of the Philippines
(Republic Act No. 8293).
in
(Date)
Affiant
in
(Number)
, affiant exhibiting to
(Place)
issued on
at
(Date)
Notary Public
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 20___.
Note: This affidavit shall be reproduced at the back of your Certificate of Copyright Registration and Deposit and
shall be admissible as prima facie evidence in any proceeding for an offense under the Chapter XVII of Republic
Act No. 8293.