Form-I - Form of Application For Certification For Public Exhibition of A Film Produced in India (See Sub-Rule (1) of Rule 21)

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FORM-I
Hkkjr esa fufeZr fQYeksa ds yksd izn'kZu ds izek.ku ds fy, vkosnu izi= |
( mifu;e (1 1) fu;e 21 dks ns[ksa )
Form of application for certification for public exhibition of a film produced in India
( See sub-rule (1) of rule 21 )
vkosnu la[;k ,oa fnukad ( cksMZ dk;kZy; }kjk Hkjk tk,xk )

No. and Date of application ( to be entered by Board's office )
lsok esa]
dsUnzh; fQYe izek.ku cksMZsa
}kjk izknsf'kd vf/kdkjh

To,
The Central Board of Film Certification
through the Regional Officer at :
Hkkjr esa fufeZr fQYe ds yksd izn'kZu ds izek.ku ds fy, vkosnu i= |

Application for Certification for public exhibition of a film produced in India at :
1- d- fQYe dk uke

(a) Name of the film :
[k- fQYe dh Hkk"kk

(b) Language of the film :
x- fQYe dh yackbZQhV esa ehVj esa

(c) Length of the film in ft. meter
?k- jhyksa dh la[;k

(d) Number of Reels :
p- fQYe dk xst
(e) Gauge of the film :
N- fQYe dk izdkj % tSls 2&Mh]] 3&Mh]] flusekLdksi ;k foLVkfot+u gS |

(f) Type of the film i.e whether it is 2D, 3D, Cinemascope, vistavision etc. :
t- D;k fQYe ewd gS ;k lokd

(g) Whether the film is silent or talkie :
>- fQYe dk jax

(h) Colour of the film :
V- fuekZrk dk uke vkSj irk

(i) Name and address of the Producer :
B- funsZ'kd dk uke
(j) Name of the Director :
2- mYys[k dhft,] fQYe lekpkj fp=@o`Rrfp=@oSKkfud@'kS{kf.kd@ Qhpj@foKkiu fQYe gSA

2. State whether the film is a newsreel/ documentary/ scientific/ educational/ feature/ advertisement film :
2(v) vkxzg fd, x, izek.ki= dks fufnZ"V dhft,% ;w] ;w,] ,] ,l

2(a) Specify the Certificate requested - 'U', 'UA', 'A' or 'S' :
3- fQYe ds usxsfVo ,oa ikstsVho fizaVksa dh la[;k vyx&vyx nsaA
3. State separately the number of negative and positive prints of the film.
d- fufeZr (usxsfVo ikstsfVo)

(a) Produced ( negative positive )
[k- vkosnd ds vf/kiR; esa ( usxsfVo ikstsfVo )

(b) In the applicant's possession ( negative positive )
x- izkslsl djusokyk ysczksVjh dk uke vkSj irk

(c) Name and address of the processing laboratory :
4- (d) orZeku fQYe D;k fdlh vU; fQYe dk Mc Hkk"kkarj gS ;k iqufuekZ.k gS\ ;fn ,slk gS rks] ml fQYe dks tkjh fd;s
x;s izek.ki= ds lkFk iw.kZ fooj.k nsaA
4. (a) Whether the present film is a dubbed version or a remake of any other film? If so, state the particulars along with full
details of certificates issued to that film.
([k) D;k iwoZ lsaljf'ki lykg fy;k x;k Fkk] ;fn gka]rks mldk iw.kZ fooj.k nsaA
(b) Whether any pre-censorship advice was obtained and if so the details thereof.
(x) fons'k esa 'kwfVax ds fy, vkns'k fy;k x;k Fkk\

(c) Whether permission for any shooting abroad was obtained and, if so, the details thereof.
(?k)
fQYe dh Hkk"kk ds vykok fQYe esa fdlh vU; Hkk"kk dk laokn@dkWfeUV~hz gS] ;fn ,slk gS rks Hkk"kk vkSj ml jhy
dk mYys[k dhft, ftlesa og gS A
(d) Whether the film contains any dialogue/ commentary in any language other than the language of the film and if
so, specify the language and the reels in which they occur.
5- Hkkjr esa yksd izn'kZu fd ;ksX; izekf.kr djus ds fy, igys dksbZ vkosnu fn;k x;k gS\ ;fn ,slk gS rks]
5. Has any previous application been made to certify this film suitable for public exhibition in India? Is so. :
(d) dgka vkSj fdls fn;k x;k \

(a) Where and to whom was it made?
([k) vkosnu dk ifj.kke D;k Fkk \

(b) What was the result of the application ?
1- ;w@;w,@,@,l izek.ki= la[;k -------------------------------------fnukad ------------------ fn;k x;kA fuEu dkaVNkaV ds 'krksaZ ij
1. 'U'/'UA'/'A'/'S' ( ) Certificate No. ( ) dated ( ) was granted to the following cuts.
2- izek.ki= bUdkj fd;k x;kA

2. Certificate was refused?
6- D;k dHkh fQYe ds yksd izn'kZu ij jksd yxkbZ x;h vFkok dsUnzh; o fdlh jkT; ljdkjksa }kjk vizekf.kr ?kksf"kr fd;k
x;k \ iw.kZ fooj.k nsaA
6. Has the exhibition of this film been at any time suspended or the film declared uncertified by the Central or any State
Government? State Particulars.
7- D;k fQYe esa vaxzsth vFkok Hkkjrh; Hkk"kkvksa ds vykok fdlh vU; Hkk"kk esa laokn] xkuk] dfork] Hkk"k.k o dkWesUV~zh gS \
7. Does the film contain any dialogue, song, poem, speech or commentary in any language other than English or in Indian
language?
;fn ,slk gS rks jhy ;k jhyksa dks mYys[k dhft, ftlesa xkuk] dfork] Hkk"k.k] laokn o dkWfeUV~zh vkrk gS vkSj iz;ksx dh
xbZ Hkk"kk gS A
If so, specify that reel or reels in which the dialogue, song, poem, speech or commentary and the language or
languages used.
(d) ;fn fQYe dkYifud ;k lR; ?kVuk ;k okLrfod dgkuh ;k ikSjkf.kd ;k egkdkO; ;k nSfod ;k thouh ij
vk/kkfjr gS rks mldk lzksr D;k gS A
(a) Specify whether the film is based on fiction or true incident or true story or mythology or epic or devotional or
biographical and if so the source from which it has been made may be mentioned :
8- fu;e 36 ds vUrxZr vkosnu ds lkFk fn;k x;k 'kqYd dk jde

8. Amount of fee accompanying the application on account of the fee prescribed in Rule 36.:
(i) jlhn la ------------------------------------------- fnukad -----------------------------------

(i) Receipt No. Dated
(ii) cSad M~zkQ~V la[;k -------------------------------- fnukad ------------------------------

(ii) Bank Draft No. _________ Date __________ on Bank _________ .
(iii) iksLVy vkWMj la[;k -------------------------------Mkd?kj------------------fnukad ------------------------------

(iii) P.O. No. _________ Post Office __________ dated __________.
9- D;k fQYe ds 'kwfVax esa fdlh i'kq dk mi;ksx fd;k x;k gS \ ;fn gks rks D;k fu;e (21) ds mifu;e (3) ds [kaM ([k
[k) esa fofufnZ"V ?kks"k.kk Qkby dj nh xbZ gS \
9. Whether any animal has been used in shooting the film? If so, whether declaration specified in clause (bb) of sub-rule
(3) of rule (21) has been filed?
10- vkosnd dk uke]irk rFkk nwjHkk"kk ua] ;fn gS rksA

10. Name, address and telephone number, if any of the applicant
11- eSa ?kksf"kr djrk gwW fd cksMZ }kjk ijh{k.k djus ds fy, fizaV rS;kj gS vkSj mij fy[ks x, fooj.k lR; gSA
11. I declare that the print of the film is ready for examination by the Board and the statements recorded above are true in
every particular.
LFkku
Place : vkosnd dk gLrk{kj
fnukad Signature of the applicant
Date : Name & Designation

Form-I - Form of Application For Certification For Public Exhibition of A Film Produced in India (See Sub-Rule (1) of Rule 21)

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vkosnu la[;k ,oa fnukad ( cksMZ dk;kZy; }kjk Hkjk tk,xk )

Hkkjr esa fufeZr fQYe ds yksd izn'kZu ds izek.ku ds fy, vkosnu i= |

1- d- fQYe dk uke

 [k- fQYe dh Hkk"kk

 x- fQYe dh yackbZQhV esa   ehVj esa

 ?k- jhyksa dh la[;k

 N- fQYe dk izdkj % tSls 2&Mh]] 3&Mh]] flusekLdksi ;k foLVkfot+u gS |

 t- D;k fQYe ewd gS ;k lokd

 >- fQYe dk jax

 V- fuekZrk dk uke vkSj irk

2- mYys[k dhft,] fQYe lekpkj fp=@o`Rrfp=@oSKkfud@'kS{kf.kd@ Qhpj@foKkiu fQYe gSA

 2(v) vkxzg fd, x, izek.ki= dks fufnZ"V dhft,% ;w] ;w,] ,] ,l

 d- fufeZr (usxsfVo  ikstsfVo)

 [k- vkosnd ds vf/kiR; esa ( usxsfVo  ikstsfVo )

 x- izkslsl djusokyk ysczksVjh dk uke vkSj irk

(x) fons'k esa 'kwfVax ds fy, vkns'k fy;k x;k Fkk\

(d) dgka vkSj fdls fn;k x;k \

([k) vkosnu dk ifj.kke D;k Fkk \

 2- izek.ki= bUdkj fd;k x;kA

8- fu;e 36 ds vUrxZr vkosnu ds lkFk fn;k x;k 'kqYd dk jde

(i) jlhn la ------------------------------------------- fnukad -----------------------------------

(ii) cSad M~zkQ~V la[;k -------------------------------- fnukad ------------------------------

(iii) iksLVy vkWMj la[;k -------------------------------Mkd?kj------------------fnukad ------------------------------

10- vkosnd dk uke]irk rFkk nwjHkk"kk ua] ;fn gS rksA

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1- d- fQYe dk uke

[k- fQYe dh Hkk"kk

x- fQYe dh yackbZQhV esa ehVj esa

?k- jhyksa dh la[;k

N- fQYe dk izdkj % tSls 2&Mh]] 3&Mh]] flusekLdksi ;k foLVkfot+u gS |

t- D;k fQYe ewd gS ;k lokd

>- fQYe dk jax

V- fuekZrk dk uke vkSj irk

2(v) vkxzg fd, x, izek.ki= dks fufnZ"V dhft,% ;w] ;w,] ,] ,l

d- fufeZr (usxsfVo ikstsfVo)

[k- vkosnd ds vf/kiR; esa ( usxsfVo ikstsfVo )

x- izkslsl djusokyk ysczksVjh dk uke vkSj irk

2- izek.ki= bUdkj fd;k x;kA