1964_FILM_CENSORSHIP_REGULATIONS — Page 10

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CAP. 392]

Film Censorship Regulations

[1988 Ed.

[Subsidiary]

FORM 4

FILM CENSORSHIP ORDINANCE

(Chapter 392)

APPLICATION FOR REPLACEMENT CERTIFICATE

[s. 25(1)]

FOR OFFICIAL USE ONLY

ORIGINAL-WHITE

(Retained by Commissioner for Television and

Entertainment Licensing)

DUPLICATE--GREEN

(Retained by applicant) (See Note 1)

Film Ref. No.:

Received on:

Application No.:

Replacement Certificate No.:

Date of Issue:

To the Commissioner for Television and Entertainment Licensing

PART A

1.

Title(s): (English):

(Chinese):

(Other Language):

(See Note 2)

2. Country(ies) of production:

3. Producer:

4.

Director:

5. Language(s) of dialogue:

6. Language(s) of subtitles:

7. Approximate running time of the film:

minutes

8. Approximate date of issue of Certificate of *Approval/*Exemption

9.

Format of film:

16mm film;

35mm film;

No. of reels:

No. of reels:

video-tape;

No. of cassettes:

laser disc;

No. of discs:

still film;

No. of slides:

10. Venues of exhibition:

others; please specify:

cinematograph theatres

others; please specify:

(Date)

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