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Cosbots App Membership Mobile Header

Application for Membership

Copyright Society of Botswana

Application for Membership

Copyright Society of Botswana

- Step 1 of 8

Section 1: Applicant Details

Application for membership.

Surname *

Initials *

Name *

Pseudonym / Stage Name *

IPI Name Number

IPI Base Number

Date of Birth *

Place Country of Birth *

Nationality *

Language *

National ID / Passport No *

Sex *

Marital Status *

Spouse

Profession *

Section 2: Addresses

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Telephone Business *

Mobile *

Fax

Telephone Home

Email *

Website

Section 3: Right Holder Roles (tick where appropriate)

Music *

Composer
Author
Arranger / Adaptor
Publisher
Performer
Producer
Other

Non Music *

Film Video
Literature
Graphic / Photograph
Visual Arts
Drama / Performing Arts

Upload Artistic Content

Section 4: Other Societies

Are you a member of any other society? *

If yes please give details

Section 5: Banking Details

Payment Method

Account Name

Bank Name

Account Number

Branch Code

Branch

I declare that the information given is true and correct, and that I am authorized to sign in my personal capacity. Should any of the above information change at any time, COSBOTS will be notified immediately to avoid any delays in payments, or payment into an incorrect bank account. In addition, I agree and accept that, in the event of the above information being incorrect, COSBOTS will not be held responsible for any delays and/or loss.

Signature Clause:

Please take note that by typing your name you agree to the terms and conditions specified.

Signature *

Date / Time *

Section 6: Managed Rights (Membership)

Copyright and neighbouring rights

Entry / Admission Date

Exit Date

Membership Status (Position)

Entry Date

Exit Date

Region or City (Residence)

Circle of Occupation

Category of work

Rights transfered to COSBOTS

Territories

File

Section 7: Next of Kin Information

Next of Kin Details *

First

Middle

Last

ID / Passport Number *

Relationship *

Next of Kin Details (Other) *

First

Middle

Last

ID / Passport Number *

Relationship *

Next of Kin Details (Other)

First

Middle

Last

ID / Passport Number

Relationship

Next of Kin Details (Other)

First

Middle

Last

ID / Passport Number

Relationship

Address

Address Line 1

Address Line 2

City

State / Province / Region

Contacts

Date

Section 8: Inheritance Information

Date *

Successor / Representative *

Address *

Address Line 1

City

State / Province / Region

Terms & Conditions

I hereby apply to be admitted as a member of COSBOTS and declare that the above information is true to the best of my knowledge and that COSBOTS shall not be held accountable in case of any false information provided by myself. I understand that my membership is subject to the membership rules of COSBOTS, the COSBOTS Constitution and the Copyright and Neighbouring Rights Act, therefore my rights, obligations and liabilities as a member shall be governed by the above mentioned statutes, in Botswana.

Signature *

Date / Time

Message

Please download our PDF form for more detailed information:

File Upload

Please take note that by downloading this form you will be able to print and sign the document, the user can scan the document and upload it to complete the application process.

Name

Please download our PDF form for more detailed information:

File Upload

Please take note that by downloading this form you will be able to print and sign the document, the user can scan the document and upload it to complete the application process.

Website

Contact us here!

Contact us here!

Our business details!

Unit 1, Plot 93
International Commerce Park
Gaborone, Botswana

Cosbots Social Media Icons Telephone-

+267 392 8055

Cosbots Social Media Icons E-mail-

info@cosbots.co.bw

Cosbots Social Media Icons Facebook

Cosbots Social Media Icons YouTube

Cosbots Social Media Icons Twitter

Cosbots Social Media Icons Linkedin

Find us here!

Our business details!

Unit 1, Plot 93
International Commerce Park
Gaborone, Botswana

Cosbots Social Media Icons Telephone-

+267 392 8055

Cosbots Social Media Icons E-mail-

info@cosbots.co.bw

Find us here!

"Copyright" Cosbots

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