Commonwealth Numbered Regulations

1990 No. 76 COPYRIGHT REGULATIONS (AMENDMENT) - SCHEDULE

                            SCHEDULE 11A               Regulation 23

RECORD OF THE MAKING OF A LICENSED COPY IN RELIANCE ON PART VB OF
THE COPYRIGHT ACT 1968
1. The name of the institution for which the
licensed copy was made: ............................ 2. The section of the
Copyright Act 1968 in
reliance on which the copy was made: ............................ 3. The day
on which the copy was made: ................................
4. The full name or the surname and initials
of the author/*s of the article or other
work(1): ............................ 5. *The name of the periodical
publication
in which the article appeared/*The title or
other identification of the work/*The title or
other identification of the sound recording or
cinematograph film: ............................ 6. *The International
Standard Serial Number
of the periodical publication in which the
article appeared/*The International Standard
Book Number of the edition containing the
works(1): ............................ 7. The name of the publisher of *the
issue
of the periodical publication in which the
article appeared/ *the edition containing the
work(1): ............................ 8. *The volume and number or the date of
publication or other identification of the
issue of the periodical publication in which
the article appeared/ *The year of publication
of the edition containing the work(1): ............................ 9. The
number of pages copied(1): ................................ 10. The number of
copies made of *each
page/*the sound recording/*the cinematograph
film/copied: ............................ 11. The form in which the copy was
made(2): ............................

*Omit if not applicable. (1) Questions 4, 6, 7, 8 and 9 should not be answered
where the item copied is a sound recording or cinematograph film. (2) Specify
the form of the copy: for example, a Braille, large-print or photographic
version, a sound recording or a cinematograph film. Question 11 should not be
completed where the form of the copy is a facsimile reproduction.