Duplicate work request

When you have completed the form, please use the ‘Submit’ button at the foot of the page to confirm your details.

Duplicate work request

Form F-05 V2.4

Fields in bold and marked with an asterisk ‘*’ are required and must be entered.

Your details

(Mr./Mrs. etc.)

Details of the work

Special instructions

Address to send to (if different from address in “your details” above)

Declaration

I hereby request a duplicate of the work detailed in this form. I certify that I am (or am acting on behalf of) the copyrights owner(s) of the work detailed in this form, and indemnify Copyright Witness Ltd against any liability for infringed copyright(or other rights) of any third party should this prove not to be the case.
 
Applicants under 18 should also obtain signature from a parent or guardian:

Payment details

Paying by cheque of postal order

Please make cheques/postal orders/international money orders for UK Pounds Sterling (GBP), and made payable to ‘UK Copyright Service’.

Paying by credit/debit card

(tick one)

Visa Credit Mastercard Visa Debit 

UK Maestro American Express 

(name exactly as it appears on the card)

 

 

(if shown)

 

 

 

 

(must be entered if it appears on your card, otherwise leave blank)

 

 

(3 or 4 digit code, normally found on signature strip)

 

 

(leave blank if not applicable)

 

Postal address including postal/ZIP code

 

 

 

We recommend that an email address or telephone number is given, in case of any problem regarding payment.

Please send completed form and payment of £26.00 per work to:

UK Copyright Service - Registration Services

4 Tavistock Avenue

Didcot

Oxfordshire

OX11 8NA

United Kingdom

The prices quoted on this form are valid until the end of June 2017. After this time please visit our web site at www.copyrightservice.co.uk to obtain a valid application form.