<p> APPLICATION FOR A COPYRIGHT & RELATED RIGHTS MUSIC LICENSE</p><p>36 Campus Avenue, West Landivar, P.O. Box 1100, Belize City, Belize TEL: 501.636.0564 Website: www.bscap.bz EMAIL: [email protected]</p><p>Please note this application will be used as your license specification.</p><p>LICENSEE DETAILS</p><p>Registered Business Name: …………….……………………………………………..……………………………………….…………….</p><p>Trading Name:…………….……………………………………….……..…………………………………………………………….…………</p><p>Contact Name: ……………………………………………………..……………………………….………………………………………………</p><p>Address:………………………………………………………………...…………………………………………………………………………..…</p><p>…………………………………………………………………………….…………………………………………….……………………………..…</p><p>Tel:………………………………………..………...... Fax:……………………………………………………………….………….….</p><p>Email:………………………….……………………………………………………………………………………………………………………….</p><p>Nature of Establishment: Hotel Night Club Restaurant Bar </p><p>Other Please specify ………………………………………………….………………</p><p>1. BACKGROUND MUSIC Please advise on seating capacity/area in square feet and category of music played in the following areas</p><p>Categories: A. Radio B. Television/Video C. Tape D. Compact Disc E. Satellite/Cable </p><p>TYPE OF AREA CAPACITY TYPE OF AREA CAPACITY TYPE OF AREA Sq. ft</p><p>Bar1 Restaurant 1 Reception</p><p>Bar 2 Restaurant 2 Entrance/Foyer</p><p>Bar 3 Veranda Passages</p><p>Lounge Cloak room Other</p><p>Guest Rooms Elevators</p><p>Other Ships/Catamarans</p><p>2. LETTING ROOMS FOR FUNCTIONS WITH MUSIC (e.g. Dances, Seminars, Receptions etc.)</p><p>NAME OF ROOM CAPACITY TYPE OF FUNCTION NO. OF FUNCTIONS/YEAR SEATING DANCING 3. FILM/VIDEO SHOWS: Number per annum ………….. Seating capacity ………………….</p><p>4. RECORDED MUSIC FOR DANCING(DINE & DANCE/DISCOTHEQUE)</p><p>DAYS OF THE WEEK SFE ADMISSION Capacity ESTIMATED ANNUAL INCOME (RECORDED ONLY) PER DAY Seating STANDING</p><p>5. LIVE PERFORMANCES (vocalists, instrumentalists & other artists, including karaoke)</p><p>DAYS OF THE WEEK LIVE ADMISSION Capacity ESTIMATED ANNUAL INCOME PERFORMANCES PER DAY Seating STANDING</p><p>6. CABARET PERFORMANCES (Recorded Music to Floor/Dance Shows)</p><p>DAYS OF THE WEEK FOR ADMISSION Capacity ESTIMATED ANNUAL INCOME PERFORMANCES PER DAY Seating STANDING</p><p>7. Music on Hold: Number of Incoming telephone lines: ……………………………………………………………………….</p><p>8. If background music or video service used, give name and address of supplier:</p><p>…………………………………………………………………………………………………………………………………………….…</p><p>Remarks – Please provide any additional details you wish to bring to our attention</p><p>Declaration: PLEASE CHECK INFORMATION SUBMITTED CAREFULLY BEFORE READING AND SIGNING THIS DECLARATION.</p><p>I DECLARE THAT THE INFORMATION SUBMITTED ON THIS APPLICATION IS, TO THE BEST OF MY/OUR KNOWLEDGE, CORRECT.</p><p>Signature of Applicant:...... </p><p>Print/Type Name:…………………………………………………………………………………………………………………….……</p><p>Position of Applicant: ……………………………………………………………………………………………………………………</p><p>Date:……………………………………………………………………………………………………………………………….…………</p><p>For Office Use Only</p><p>Number of Premises: Number of Licenses:</p><p>New Lic. No. Applied Tariffs:</p>