Films and Publications Act, 1996 (Act No. 65 of 1996)

Regulations

Purchase

Annexure F

BOARD/GM

FILM AND PUBLICATION BOARD

420 WITCH HAZEL, ECO GLADE 2, ECO PARK

CENTURION 0169

PRIVATE BAG X 31, HIGHVELD 0169

Request for classification of games

[regulation 16]

The Film and Publication Board may refuse to process your application if this form is not fully completed

Ref No (Office use)

DATE OF APPLICATION

DATE RECEIVED (Office use)

APPLICANT

POSTAL ADDRESS
		POSTAL CODE

CONTACT PERSON

TEL

FAX

E-MAIL

FORAMAT

CONSOLE

ARCADE

MOBILE GAME

OTHER

PROOF OF RIGHT TO DISTRIBUTE GANE IN THE REPUBLIC OF SOUTH AFRICA

DESCRIPTION OF GAME PLAY AND TARGET MARKET
ORIGINAL	ADD-ON	COMPILATION	BUDGET-LINE

ELSPA RATING

REASON FOR RATING

NOTE:

1.	Proof of your right to distribute or exhibit this game in South Africa, in the format submitted, must be attached to this form.

2.	Unless exempted from the cash-on-submission basis, payment in full of the applicable amount must be made before this application may be processed. Where payment has been made by direct deposit into the account of the Board, proof of such deposit must be attached to this form.

3.	You must provide, free of charge, a copy of this game, to the Board for its records.