1.

The name of the institution for which the broadcast was copied:

.................................

2.

The day on which the copying was carried out:

.................................

3.

The title, or other identification, of the program or programs included in the broadcast:

.................................

4.

The name or call sign of the broadcasting station that made the broadcast:

.................................

5.

The day on which the broadcast commenced:

.................................

6.

The time when the broadcast commenced:

.................................

7.

The number of copies made of the broadcast:

.................................