OFFICIAL GAZETI'E· GOVT. OF GOA SERIES I No. 50 (EXTRAORDINARY) 22ND MARCH, 2006 DEPARTMENT OF INFORMATION AND PUBLICITY Government of Goa APPLICATION FORM FOR REGISTRATION OF FILM PRODUCERS 1. Name of the producer ....................................... ............................................... Age ..............................................Sex ........... ................ 2. Address Office: ............... ............... ......... .................. ............................. ...... . ........ .......................................... ........... Tel: .............. ................................. . Residence: ........ ..........:.................. Tel: ...................... ....... ........ 3. Rep. By ........................................................ : .................................................... . 4. State whether Individual, Partnership, Limited Co. or Society .................................................... 6. Have you produced any Films/Dramas/Musical program/any events: Yes/No. If yes, give details: ............................................................................................ 6. Whether you intend to produce video films or celluloid films? ................................................... 7. In which language you intend to produce the film Konkani/Marathi/Hindi/English: ....................................................................... 8. Any other information you wish to give to consider your application for registration as film producer: I/WE HEREBY DECLARE THAT WHATEVER INFORMATION PROVIDED IN THIS FORM IS CORRECT TO THE BEST OF MY/OUR KNOWLEDGE AND BELIEF AND NO PART OF IT IS FALSE (if the information given is found to be false the application shall be rejected) (Name of the Film Producer) GOVERNMENT PRINTING PRESS, PANAJI- GOA. Price: Rs. 8.00
