MUSIC COPYRIGHT LICENCE APPLICATION FORM 1- APPLICANT (To complete) Type of Business Karaoke Lounge Discotheque Nightclub Pub Bar Bistro Restaurant Cafe --------------------- Departmental Store Supermarket Shopping Centre Boutique Retail Shop Record Shop Beauty & Slimming Centre Hair Saloon Fitness Club Aerobic Centre Dancing School Bowling Centre Skating Rink Amusement Park --------------------- Medical Centre Hospital Clinic --------------------- Office Factory Showroom Banking Premises --------------------- Hotel Service Apartment Private/Members Club --------------------- Other (please describe)    If other: Business Registration No Name of Premises Address of Premises Postcode Town/City State Johor Kedah Kelantan Labuan Melaka N Sembilan Pahang Perak Perlis Pulau Pinang Putrajaya Sabah Sarawak Selangor Terengganu Wilayah Persekutuan   Telephone No. - Fax No. - Name of Management Address of Management Postcode Town/City State Johor Kedah Kelantan Labuan Melaka N Sembilan Pahang Perak Perlis Pulau Pinang Putrajaya Sabah Sarawak Selangor Terengganu Wilayah Persekutuan Other If outside Malaysia : Country Telephone No. - Fax No. -   2- PREMISES (Please complete the relevant section only) 2a   Lounge, Discotheque, Nigtclub, Pub, Bistro, Restaurant & Cafe Maximum capacity - sitting Maximum capacity - standing   No. of TV screens No. of Jukeboxes (if any) Live music (band, singers, performers) Yes   No Dancing facility Yes    No 2b   Departmental Store, Supermarket, Shopping Centre, Boutique, Retail Shop, Record Shop, Beauty & Slimming Centre, Hair Saloon, Fitness Club, Aerobic Centre, Dancing School, Bowling Centre, Skating Rink, Amusement Park. Total floor area (in square feet) No. of TV screens (if any) No. of Jukeboxes (if any)     2c   Medical Centre,Hospital& Clinic No. of Rooms with TV Music in Lobby / reception Yes  No     2d   Office, Factory, Showroom & Banking Premises No. of Employees to whom Music is provided Average No. of visitors per day No. of telephone lines with Music-On-Hold No. of TV screens (if any)     2e   Hotel, Service Apartment and Private/Members Club No. of Rooms with TV Music in Lobby / reception Yes  No Outlet(s) located in the Premises : Name of Outlets Sitting Capacity Standing Capacity Mechanical Music (recorded) Live Music (band/ performers) No. of TV screens (if any) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes         3   I/We hereby apply for a licence from MACP which subject to the terms and conditions set out in the Licence Contract authorises the public performance of any and all of the works within MACP's repertoire, together with any words usually associated therewith, by any means whatsoever at the Premises set out above. Name of Applicant Designation NRIC number Gender Male   Female Email address Handphone no. -- 010 011 012 013 016 017 018 019 WebsiteURL (if any) Click the buttons below to submit the form or to reset the information you have filled above.