Application Form for Song Using (Arrangement)

Application date / / BANDAI NAMCO Arts Inc.

Address

Company name Representative Person in charge TEL/FAX / E-mail

Application form for song using (Arrangement)

１． Music works information Song title JASRAC code Lyricist Original singer Composer

２．Details of song using Form ☐VOCAL ☐INST Lyric ☐Original ☐Translation（Language ） ☐Other modification etails of arrangement

＊Please write down the details of the arrangement. ＊When using the lyric of translation, please write down the translated title, the name of translator and attach the lyric and its Japanese translation to the application form. Arranger

３． Purpose of use Event name Event date / / Number of events In total Time of performance : : Venue name Entrance fee Singer/Performer Performance style ☐Orchestra ☐Piano ☐Solo ☐Other（ ） Composition of instruments ＊Please fill in the details here. Recording ☐Voice Recording only ☐Recording (Voice & Movie) ☐No planning (Voice & Movie)

４． For other usage ＊For other usage such as upload to YouTube or other streaming service, please fill in the details here.

Required responding time limit | //

Notes  This application form is only available for the use of education or a non-profit purpose.  We might not be able to inform you the result of your application within the time limit you required.  After submitting your application, if you want to cancel or make any modification in the application, please contact us as soon as possible.  With regard to the arrangement of the cover song, please make sure the arranger agrees to give up all rights and will not to request any rights.  The content of performance is forbidden to launch any internet streaming service or sell as the CD・DVD・BD  For performance using, please apply to the Japanese Society for Rights of Authors, Composers and Publishers (JASRAC).

Ver.18.09