H6B

SOUTHERN AFRICAN MUSIC RIGHTS ORGANISATION
PART A: LICENSEE DETAILS
Business Name
Company Registration No.:
Please select the type of organisation:*

Pty) LtdCCTrustSole ProprietorPartnershipNGOOrgan of the stateOther:Specify
VAT Registration No.:
Identity No
License Representative Name
Designation
E- Mail Address
example@example.com
Telephone No.
Website
Fax No.
Physical Address
Building Floor
Street No.
Suburb
City/Town
Province
Postal Code
Postal Code 2
Postal Address
PART B: PREMISES DETAILS
Premises Name
Contact Name
Designation
E mail Address
example@example.com
Telephone No.
Website
example@example.com
Fax No.
Physical Address
Building Floor
Street & Number
Suburb
City/Town
Province
Postal Code
(If there are more than one premise kindly complete and submit a schedule with the aforementioned details of each premises)
File Upload

Cancelof
PART C: LICENCE PARAMETERS
No. of Premises
Total Seating Capacity of the Premises
PART D: LICENCE DETAILS
Month
Year (Last 2 digits)
PART F: SIGNATORIES FOR AND ON BEHALF OF THE LICENSEE:
Who warrants that he/she is duly authorised to sign this Agreement and is fully aware of the stipulations contained herein
Signature

Clear
Name
Designation
Date

MonthDayYear
Date
Show Example

Yes
Should be Empty:

SOUTHERN AFRICAN MUSIC RIGHTS ORGANISATION