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APPLICATION FORM
Malaysia Documentary Pitch Trailer 2014 (DocsTrailer)
A APPLICANTS INFORMATION 1. Company name
2. Address
3. Contact Person 4. Designation
5. Contact number Phone: Fax:
6. Email
7. Company Profile
8. Company Website
B PRESENTATION 9. Documentary Title
10. Genre/Style
Country’s History Nature & Wildlife Social Issues Unsung Heroes Science and Technology Paranormal 11. Cross Media (Yes/No)
12. Duration
13. No. of Episodes 14. Language 15. Logline
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16.
Project Synopsis (Not more than 1000 words)
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C DIRECTOR 17. Name
18. Profile
19. Email
20. Contact Number Mobile: Work:
D PRODUCER 21. Name
22. Profile
23. Email
24. Contact Number Mobile: Work:
E CHECKLIST
Malaysian small and medium sized company status as defined by SME Corp
Received content development fund from other government agencies not more than 2 times
Registered with FINAS
F FINANCIAL DETAILS
Amount required for Production of Trailer RM
Total Production Budget RM
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G DECLARATION For Companies
a) I, _______________________ (IC. No:________________ ) have been duly authorised by the board of directors of (“the Company”) to execute this declaration and hereby declare that the information contained in this application forwarded to the Malaysian Communications and Multimedia Commission (‘’MCMC”) is true, accurate and complete to the best of my knowledge and belief and that I have not withheld/ distorted any material facts.
b) I also declare that the company is free from any litigation pending litigation, claims, demands or actions pertaining to the proposed project. I understand that if the grant is obtained by false or misleading statements, the company may be prosecuted and in addition, MCMC may, at its discretion, withdraw the grant and recover immediately from my company any amount of the grant that may have been disbursed.
c) I acknowledge that the decision of MCMC shall be final and shall not be subject to any appeal.
Signature: Date of application:
Designation: Registered company stamp:
Name (in BLOCK letters):
