36 Campus Avenue, West Landivar, P.O. Box 1100, Belize City, Belize

APPLICATION FOR A COPYRIGHT & RELATED RIGHTS MUSIC LICENSE

36 Campus Avenue, West Landivar, P.O. Box 1100, Belize City, Belize TEL: 501.636.0564 Website: www.bscap.bz EMAIL: [email protected]

Please note this application will be used as your license specification.

LICENSEE DETAILS

Registered Business Name: …………….……………………………………………..……………………………………….…………….

Trading Name:…………….……………………………………….……..…………………………………………………………….…………

Contact Name: ……………………………………………………..……………………………….………………………………………………

Address:………………………………………………………………...…………………………………………………………………………..…

…………………………………………………………………………….…………………………………………….……………………………..…

Tel:………………………………………..………...... Fax:……………………………………………………………….………….….

Email:………………………….……………………………………………………………………………………………………………………….

Nature of Establishment: Hotel Night Club Restaurant Bar

Other Please specify ………………………………………………….………………

1. BACKGROUND MUSIC Please advise on seating capacity/area in square feet and category of music played in the following areas

Categories: A. Radio B. Television/Video C. Tape D. Compact Disc E. Satellite/Cable

TYPE OF AREA CAPACITY TYPE OF AREA CAPACITY TYPE OF AREA Sq. ft

Bar1 Restaurant 1 Reception

Bar 2 Restaurant 2 Entrance/Foyer

Bar 3 Veranda Passages

Lounge Cloak room Other

Guest Rooms Elevators

Other Ships/Catamarans

2. LETTING ROOMS FOR FUNCTIONS WITH MUSIC (e.g. Dances, Seminars, Receptions etc.)

NAME OF ROOM CAPACITY TYPE OF FUNCTION NO. OF FUNCTIONS/YEAR SEATING DANCING 3. FILM/VIDEO SHOWS: Number per annum ………….. Seating capacity ………………….

4. RECORDED MUSIC FOR DANCING(DINE & DANCE/DISCOTHEQUE)

DAYS OF THE WEEK SFE ADMISSION Capacity ESTIMATED ANNUAL INCOME (RECORDED ONLY) PER DAY Seating STANDING

5. LIVE PERFORMANCES (vocalists, instrumentalists & other artists, including karaoke)

DAYS OF THE WEEK LIVE ADMISSION Capacity ESTIMATED ANNUAL INCOME PERFORMANCES PER DAY Seating STANDING

6. CABARET PERFORMANCES (Recorded Music to Floor/Dance Shows)

DAYS OF THE WEEK FOR ADMISSION Capacity ESTIMATED ANNUAL INCOME PERFORMANCES PER DAY Seating STANDING

7. Music on Hold: Number of Incoming telephone lines: ……………………………………………………………………….

8. If background music or video service used, give name and address of supplier:

…………………………………………………………………………………………………………………………………………….…

Remarks – Please provide any additional details you wish to bring to our attention

Declaration: PLEASE CHECK INFORMATION SUBMITTED CAREFULLY BEFORE READING AND SIGNING THIS DECLARATION.

I DECLARE THAT THE INFORMATION SUBMITTED ON THIS APPLICATION IS, TO THE BEST OF MY/OUR KNOWLEDGE, CORRECT.

Signature of Applicant:......

Print/Type Name:…………………………………………………………………………………………………………………….……

Position of Applicant: ……………………………………………………………………………………………………………………

Date:……………………………………………………………………………………………………………………………….…………

For Office Use Only

Number of Premises: Number of Licenses:

New Lic. No. Applied Tariffs: