Application for reclassification of in terms of section 18B

[regulation 15]

The Film and Publication Board may refuse to process your application if this form is not fully completed

Reg Office No.:

DATE OF APPLICATION

DATE RECEIVED (Office use)

DATE OF PREVIOUS CLASSIFICATION

PREVIOUS CLASSIFICATION DECISION

APPLICANT

POSTAL ADDRESS

POSTAL CODE

CONTACT PERSON

TEL

FAX

E-MAIL

TITLE (for distribution/exhibition)

PREVIOUS TITLE (if different)

ORIGINAL

RE-RELEASE

FORMAT

35MM

VIDEO

DVD

VCD

CD- ROM

OTHER

RUNNING-TIME IN MINUTES, AS SUBMITTED

SUBJECT OR GENRE

DIRECTOR

CAST INCLUDES

LANGUAGE

ORIGINAL

DUBBED

SUB-TITLED

PREVIOUS CLASSIFICATION AND CONSUMER ADVICE

CERTIFICATE

NUMBER

FORMAT

SIGNED

DATE

CAPACITY