**Copyright Application Information Form for Literary Work**

Applicant Information

1. Full Name: ______________________________
2. Address: ______________________________
   • City: ________________
   • State/Province: ________________
   • Zip/Postal Code: ________________
   • Country: ________________
3. Email Address: ______________________________
4. Phone Number: ______________________________

Work Information

1. Title of Work: ______________________________
2. Type of Work: (e.g., novel, poem, essay, script, etc.) ______________________________
3. Date of Creation: //________ (MM/DD/YYYY)
4. Publication Status:
   • [ ] Not Published
   • [ ] Published
5. Date of Publication (if applicable): //________ (MM/DD/YYYY)
6. Publisher Information (if applicable):
   • Publisher Name: ______________________________
   • Publisher Address: ______________________________
   • City: ________________
   • State/Province: ________________
   • Zip/Postal Code: ________________
   • Country: ________________

Authorship Information

1. Author’s Full Name: ______________________________
2. If multiple authors, please list all authors:
   • 
     
     1. 
        
        
     
     
     
     
     2. 
        
        
     
     
     3. 
        
        
   • (Add more lines if necessary)
3. Is there an agreement regarding co-authorship?
   • [ ] Yes
   • [ ] No

Copyright Ownership

1. Is the work a joint work?
   • [ ] Yes
   • [ ] No
2. If yes, please provide details on ownership shares:
   • 
     
     

Declaration
I hereby declare that the information provided above is accurate and complete to the best of my knowledge. I understand that any false information may result in the rejection of the copyright application.

Signature: ______________________________
Date: //________ (MM/DD/YYYY)

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