Application for a Registration / Renewal Certificate: Distributor / Exhibitor of Films or Games

Film and Publication Board

Private Bag X31, Highveld, 0149
Eco Glades 2, 420 Witch Hazel Avenue, Eco Park, Centurion

Tel: 0800 000 555 e-mail: clientsupport@fpb.org.z

Application for a Registration / Renewal Certificate: Distributor / Exhibitor of Films or Games
In terms of Section 18 (1)(a) and/or Section 27A (1) of the Films and Publications Act, 65 of 1996 (Act), as amended
The Board may refuse to process your application if this form is not completed in full

Please select applicable option:

Please provide registration number FPB8/

PROSPECTIVE DISTRIBUTOR / EXHIBITOR INFORMATION

BUSINESS NAME:

TRADING NAME (if different from name above):

ADDRESS (physical address)

CITY / TOWN:

PROVINCE / STATE:

COUNTRY

POSTAL ADDRESS (where copy of Registration / Renewal Certificate will be sent)

EMAIL ADDRESS (where certificate will be emailed)

CONTACT PERSON:

TEL

CELL

E-MAIL

NATURE OF BUSINESS

In terms of section 27A (1)(b) of the Act, Internet Service Providers must indicate all measures, or steps taken or put in place to ensure that children are not exposed to child pornography and pornography. Fill in below:

DOCUMENTS REQUIRED

Proof of registration of the business in terms of the applicable legislation

Tax Compliance Status (Pin Issued)

Submit a declaration of compliance

Proof of payment of Applicable fee

2H License (Adult Distributors)

NB: No license will be issued without all the required documents

Banking Details:

Account: FPB t/a State Expenditure
Bank: ABSA,
Branch: Adderley Street
CAPE TOWN
Account No: 40-7589-3541
Branch Code: 632 005
Reference: Your trade or business name

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