PERSONAL DETAILS:
(Please fill in ALL fields)

EFFECTIVE DATE
(Admin. use ONLY)

Band / Act Name: Real Name:

Address:

Town: County: PostCode:

Email: (REQUIRED) Telephone:

SCOPE OF AGREEMENT

FULL CATALOGUE (And / Or) SPECIFIC TITLES

TERRITORY COVERED

WORLD (And / Or) SPECIFIC REGION(S)

SPECIFIC SONG TITLES: (If Applicable)

Title 1: Title 2:

Title 3: Title 4:

Title 5: Title 6:

Title 7: Title 8:

Title 9: Title 10:

Title 11: Title 12:

Title 13: Title 14:

Title 15: Title 16:

Title 17: Title 18:

COMPOSED BY / SIGNATURES:
(Include PRS CAE Number if applicable)

Name 1: CAE: ¦ Name 2: CAE:

Name 3: CAE: ¦ Name 4: CAE:

Name 5: CAE: ¦ Name 6: CAE:

(Please complete a separate form for different combinations of songwriters)

ADVANCE OPTIONS:
(If Applicable)

N/A Single Release Recording Session Cash Advance

Full full details of Advance Options - HERE

HOW DO YOU WISH TO RECEIVE FUNDS? :

PayPal (Linked to the email address given above) Bank Transfer (UK Only)
Wire Transfer (International Only) MoneyGram / Western Union (International Only)

UK BANK DETAILS (If Bank Transfer Selected):

BANK NAME / BRANCH: SORT CODE:

ACCOUNT NO.: ACCOUNT NAME:


INTERNATIONAL BANK DETAILS (If Wire Transfer Selected):

BANK NAME / BRANCH: BIC / SWIFT CODE:

IBAN NO. / ACCOUNT NO.: ACCOUNT NAME:

FULL TERMS AND CONDITIONS
(Please Read Before Submitting Your Form)



CLICK ABOVE TO SUBMIT YOUR FORM
(All details are sent through a SECURE server)
OR

your completed form to:-

MAORI MUSIC Publishing (UK)

The Bungalow, Cadman Lane, SNAITH, EAST YORKSHIRE DN14 9JR ENGLAND (UK)

PRS/MCPS CAE : 159804347
PPL Membership No.: 0102463585
SoundExchange Membership No.: 1000017931