COMPOSER / AUTHOR APPLICATION FOR MEMBERSHIP

1 NON-PROFITMAKING NO SHARE. P O BOX 31609. CAPITAL LIMITED BY GUARANTEE Braamfontein 2017. AFFILIATED TO THE INTERNATIONAL TEL: (011) 712-8000. CONFEDERATION OF COPYRIGHT FAX: (011) 403-1834. SOCIETIES CISAC. (Reg. No. 1961/002506/09). EMAIL: COMPOSER / AUTHOR APPLICATION FOR MEMBERSHIP . Read the following instructions before proceeding with the APPLICATION Please Note: Completion and submission of this APPLICATION does not automatically entitle you to MEMBERSHIP . SAMRO has a formal Election Process and, should you meet the Criteria of MEMBERSHIP , you will be notified in writing. PERSONAL DETAILS: This section is of vital importance and care should be taken in completing it. The following should be taken into consideration: Pseudonyms: Provision has been made for up to 8 pseudonyms. These must be genuine pseudonyms and not merely another form of your name. ID No: Your identity number as it appears in your South African Identity Document.

2 If you are not a South African Citizen, please furnish your passport number. BIOGRAPHICAL DETAILS: SAMRO needs to know about you and the history relating to your musical career. CLOSEST RELATIVE NOT LIVING WITH YOU: Please indicate the name of the person whom we should contact in the event of your death or not being able to contact you. Remember to advise us of any change in these details. BENEFICIARY DETAILS: It is important that you furnish us with the full details of your beneficiaries. BANK ACCOUNT DETAILS: SAMRO needs to have your banking details in order to be able to pay royalties to you if due. Do you have a Will? It is important that you have a Will as this makes the payment of royalties to your heirs easier for SAMRO to process in the event of your death. Without a Will your estate could take years to be finalised, during which SAMRO will have no choice other than to release monies to the estate. PLEASE ATTACH A COPY OF YOUR ID TO THE COMPLETED APPLICATION FORM.

3 PERSONAL DETAILS. Title: Surname: Full Names: (as per ID). Gender: Male Female Date of Birth: Nationality: Country of Birth: ID Number: If not South African Citizen, Passport Number: Expire Date: Correspondence Language: Residential Address: Postal Address: Code: Code: Telephone Number: Cell Phone Number: Fax Number: Email: Pseudonyms: ( Joe Rocky Smith = Rocky). 1. 5. 2. 6. 3. 7. 4. 8. Are you a member of these Rights Administration Organisations? SARRAL NORM. Are you a member of any other CISAC Society? Yes No If Yes, specify: BIOGRAPHICAL DETAILS. Are you a: COMPOSER AUTHOR Arranger When did you start your musical career? Year Type of music: Kwaito Folk Gospel Adverts / Jingles Jazz Pop Rock Hip Hop House Rap R&B / Soul Traditional Reggae Choral Boeremusiek Mbaqanga / Maskandi Classical Various Film Scores Country / Western Performers of your music? Self Others Both (Others and Self). Have you worked with other composers or authors ?

4 Yes No If Yes, please name them: 1. 2. 3. 4. 5. Have you worked with other performing artists or bands? Yes No If Yes, please name them: 1. 2. 3. 4. 5. Has your music been recorded? Yes No If Yes, please complete the table below: Name of Album Artist / Band Name of Record Label Performances: Live Performances None Local Abroad TV Performances None Local Abroad Film Performances None Local Abroad Radio Performances None Local Abroad Recorded Performances None Local Abroad Have you ever won any music prize(s), award(s), talent show(s) or special recognition? Yes No If Yes, please complete the table below: Name of prize, award, talent showcase or special recognition Year CLOSEST RELATIVE NOT LIVING WITH YOU. Title: Surname: Full Names: (as per ID). Relationship to you: Residential Address: Postal Address: Code: Code: Telephone Number: Cell Phone Number: Fax Number: Email: Correspondence Language: BENEFICIARY DETAILS. 1. Surname: Full Names: (as per ID).

5 ID Number: Residential Address: Telephone Number: Relationship to you: Code: 2. Surname: Full Names: (as per ID). ID Number: Residential Address: Telephone Number: Relationship to you: Code: 3. Surname: Full Names: (as per ID). ID Number: Residential Address: Telephone Number: Relationship to you: Code: 4. Surname: Full Names: (as per ID). ID Number: Residential Address: Telephone Number: Relationship to you: Code: BANK ACCOUNT DETAILS. Full Names: (as per ID). Account Holder's Name: Bank Name: Account Number: Branch Code: Name of Branch: Type of Account: APPLICATION FOR MEMBERSHIP - ADDENDUM. ELECTION OF RIGHTS TO BE ADMINISTERED BY SAMRO. SAMRO will administer the following rights on my behalf: - PERFORMING RIGHTS. - MECHANICAL RIGHTS. If you do not want SAMRO to administer Mechanical rights, please draw a line through "MECHNICAL RIGHTS" above and sign your name next to it. DECLARATION. I, hereby apply to be admitted as a member of the Southern African Music Rights Organisation (SAMRO) in terms of its Memorandum and Articles of Association.

6 If admitted, I agree to abide by the terms of those documents, as well as the Organisation's Rules and Regulations. I further acknowledge that should I be admitted as a member of SAMRO's Retirement Annuity Fund for its Members, the Rules of the fund will be binding upon myself and every person who may derive a claim upon the fund from me. I hereby declare that I am not a member of any performing and / or mechanical rights Organisation or Society in any other country, or SAMRO territory and that the details contained in this APPLICATION form are correct. Signed at on this day of 20. Full Name: Return completed documents to: SAMRO Customer Services Signature: Department PO BOX 31609. BRAAMFONTEIN. 2017.