Copyright Request Form s1

CARIBBEAN EXAMINATIONS COUNCIL

COPYRIGHT USAGE REQUEST FORM

APPLICANT’S NAME: DATE: (State company name, if applicable) (dd/mm/yyyy)

APPLICANT’S ADDRESS: (State company address, if applicable)

TELEPHONE NUMBER: FAX NUMBER: E-MAIL ADDRESS:

ITEM(S) REQUESTED AND SOURCE: (Specify which items and where they were found. Include name of examinations, page numbers, dates, etc)

INTENDED USE: (1Commercial aspects of your product – publication, CD, website, etc – and the method and form of marketing)

DETAILS: (Additional significant information)

I, ______, the undersigned, agree on behalf of the abovementioned entity to abide by the Terms and Conditions for the Granting of Permission for use of CXC® Copyright Materials.

NAME: (Please print)

TITLE:

SIGNATURE:

Please complete and return by mail, e-mail, or fax to:

The Senior Assistant Registrar Examinations Development and Production Caribbean Examinations Council The Garrison, St Michael BB14038, BARBADOS Tel: +1 (246) 227-1700: Fax: +1 (246) 429-5421; Email: [email protected]

Note: The approximate time for receiving a response to a request is six to eight weeks.