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NAME AND EMBLEM OF SOCIETY
FORM D
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(regulation 37 (5)
MONTHLY RETIJRNS OF WORKS USED OR PERFORMED
Name of User or Perfonnance of Work
Date: .............................. .
Time-From:
Title ofWork
Type of use or Perfonnance ........................................... .
To:................
Compiler/Producer:
Work Origin
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Type of Work
Creator/Composer/ ProducerlPublisher
Author
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I/We declare onlour honour that the return of works stated above as broadcasted were actually broadcast to the best of my I
our knowledge and belief.
DATE: ............................. MANAGER OF USER OR PERFORMER ..................,... SIGNATURE:
RETURN COMPLETED FORM TO
(NAME OF SOCIETY) WITHIN 7 DAYS OF THE USE OR PERFORMANCE
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