Application for a FPB license as a Distributor of Adult of Adult Films

The Board may refuse to process your submission if this form is not completed in all details

Ref.No. (Office use..............................................................................................................

Applicant/Owner)...............................................................................................................

Identity Number..................................................................................................................

Postal Address (Where license will be posted).....................................................................

.................................................................Postal Code (Compulsory)....................................

Tel.........................................Fax..........................................e-mail......................................

Cell.................................................................

Contact Person.....................................................................................................................

Business Name (if different to applicant name)....................................................................

Address (Physical Address where business is carried out)......................................................

.............................................................................Province..................................................

SARS Tax Reference No.........................................................................................................

Nature of Business (tick one or more)                        Distributor of Adult Films

Business of adult premises

Other (please describe)

Document Required:        Certified copy tax clearance certificate

NB: Validity of Certificate will be confirmed with SARS

Proof of payment of applicable fee

License to conduct the business of adult premises (Adult Premises) i.t.o item 2(h) act 71 of 1991

Other (Please describe)....................................................................

Applicants Signature .............................................................................................................

Capacity................................................................................................................................

Date......................................................................................................................................

NB: No license will be used issues without all of the required documents

Comments (Office use).........................................................................................................

.............................................................................................................................................

Date......................................................................................................................................