PERMIT LICENCE APPLICATION FORM (In compliance with the Copyright Act 1987) 1- APPLICANT (To complete) Name of Business (Company/Sole Trader) ("the Applicant") Business Registration No Address Postcode Town/City State Johor Kedah Kelantan Labuan Melaka N Sembilan Pahang Perak Perlis Pulau Pinang Putrajaya Sabah Sarawak Selangor Terengganu Wilayah Persekutuan Other Country Telephone No - Fax No - 2 - EVENT (To complete) Name of event Dates and venues No. Event date (s) Venue 1. 2. 3. 4. Name of Artiste(s) / Performer(s) Name of Music Machine / Sound System supplier Address 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. - Contact Person Mobile No. -- 010 011 012 013 016 017 018 019 3- Please complete the relevant section only 3a   ONE-OFF MUSICAL EVENT(S) such as Dinner and Dances, Luncheon/Dinner Shows, Graduation Balls, Product Launching, Family Days, Free Concerts, Fashion Shows and Beauty Pageants. Permit Licence Fee The fee payable to MACP shall be 15% of Total Expenditure on the Provision of Music subject to a minimum fee of RM400.00. Total expenditure on Artiste(s) / Performer(s) RM Total expenditure on Music Machine/Sound System etc. RM TOTAL EXPENDITURE ON THE PROVISION OF MUSIC RM   x 15%     3b   CASUAL PUBLIC PERFORMANCES(including exhibitions) at concourses and arcades of complexes Permit Licence Fee Entertainment with Performers/DJ/Compere Only RM300.00 per day   No. of days days x RM300.00    3c   CASUAL PUBLIC PERFORMANCES for Exhibitions, Seminars and Conferences Permit Licence Fee Duration Low Music Density* High Music Density** 1 - 2 days RM200.00 per day RM300.00 per day 3- 6 days RM150.00 per day RM250.00 per day 7 - 14 days RM100.00 per day RM200.00 per day 15 days or more RM 75.00 per day RM175.00 per day * Low Music Density means with mechanical background music only ** High Music Density means with performers or audio and video appliances No. of days with Low Music Density days No. of days with High Music Density days 3d   TICKET SELLING EVENT(S) such as Concerts, Circus and Funfairs. Permit Licence Fee The fee payable shall be 2% on the Total Value of Tickets Sold PLUS 1% on the Value of Complimentary Tickets given out. The fee is subject to a minimum fee of RM500.00 A deposit is required BEFORE the event by multiplying the 2% rate to 60% of the Total Value of Tickets on Sale and is to be paid by way of bank draft at least 7 working days before the first performance. The actual fee will be calculated AFTER the event based on the Ticket Sales Report.        Ticket Value No. of Tickets Printed RM  x RM  x RM  x RM  x RM  x Complimentary tickets 4   I/We apply for aPermit Licence from MACP which is subject to the terms and conditions set out on this Permit Licence Application Form. The particulars given are correct and I/We agree that the information shall form the basis of the Permit Licence issued. An agreement is deemed to have been made only upon the acceptance and execution of this application by MACP. Name of Applicant Designation NRIC number Gender Male   Female Mobile no. -- 010 011 012 013 016 017 018 019 Email address Click the buttons below to submit the form or to reset the information you have filled above.

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