Download I want to use a work / music in a film

Internationale Musikverlage
Hans Sikorski GmbH & Co. KG
- Licensing / Film Licence Johnsallee 23
20148 Hamburg
Germany
Phone:+49 (0)40 / 41 41 00 - 47
Fax: +49 (0)40 / 41 41 00 - 41
Email: [email protected]
I want to use a work / music
in a film
Please give a description of your intended exploitation
1.Please indicate the following details of the projected film:
Film titel:
Total duration of the film:
Producer(s):
Director:
Leading actors / actresses:
Budget of the production:
What kind of film is it? (musical film / feature film / documentary film etc.):
2.Which work / music do you want to use?
Composer: Arranger:
Work title: Title of excerpt:
Further details (language, version):
3.How often is the work going to be heard in the projected film?
Duration of each excerpt:
4.Do you intend to use the music as title theme or in the credit section?
Will you use the work as background music? Yes No
Is your film going to be a recording of a concert? Yes No
Date of the performance:
Orchestra:
Conductor:
Is the intended production going to be a 'portrait film'? Yes No
Please describe the used sound carrier (CD etc.):
Title:
EAN code:
Is it an own production? Yes No
Interpreter:
Will the work be used in its original version or will the work / text be arranged or altered?
Original Version
Arrangement
What kind of changes?
(If applicated please attach the changed text)
Please indicate the character and the scope of your exploitation
In which territory are you intending to place the advertisement?
For how long (period) do you intend to advertise / use the music?
What kind of exploitation do you intend? (Please fill in where applicable)
DVD production
CD-ROM production
Video production
Circulation:
Sales price:
Circulation:
Sales price:
Circulation:
Sales price:
TV Cinema Internet Festival
How to contact you?
Name / Company:
Customer number (if extant):
Personal contact:
Phone:
Address:
Fax:
Email:
Country:
VAT ID:
Please understand that we have to reserve the right to check your data. We will process your enquiry as
soon as possible and submit our offer. Please note that the work/works may only be exploited after both
parties have signed an agreement and a licence fee has been paid.
Place / Date
Signature
This form is also to be found on our website:
www.sikorski.de