Please enable JavaScript in your browser to complete this form. - Step 1 of 8Date Form Submitted: *Section 1: Applicant DetailsApplication for membership.Surname: *Full Names: *Pseudonym / Stage Name: *Date of Birth: *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Place Country of Birth: *Nationality: *Language: *National ID / Passport No: *Gender: *Click to chooseMaleFemaleMarital Status: *Click to chooseSingleMarried DivorcedSpouse:Employment Status: *Click to chooseEmployedUnemployedSelf EmployedCircle of Occupation:NextSection 2: AddressesPhysical Address: *Address Line 1CityState / Province / RegionPostal Address: *Address Line 1CityState / Province / RegionMobile Number: *Email:Website / URL:PreviousNextSection 3: Right Holder Roles (tick where appropriate)Category of Works: *Sound RecordingsMusical WorksAudio VisualLiterary Visual ArtsMusic: *ComposerAuthorArranger / AdaptorPublisherPerformerProducer OtherN/ANon Music: *Film VideoLiteratureGraphic / PhotographVisual ArtsDrama / Performing ArtsN/AUpload Artistic Content: Click or drag files to this area to upload. You can upload up to 10 files. PreviousNextSection 4: Other SocietiesAre you a member of any society: *Click to chooseYesNoIf yes please give details:PreviousNextSection 5: Banking DetailsBank Name:Account Name:Branch:Account Number:Branch Code:Payment Method:Signature Clause:Please take note that by typing your name you agree to the terms and conditions specified.I declare that the information given is true and correct, and that I am authorized to sign in my personal capacity. Should any of the above information change at any time, COSBOTS will be notified immediately to avoid any delays in payments, or payment into an incorrect bank account. In addition, I agree and accept that, in the event of the above information being incorrect, COSBOTS will not be held responsible for any delays and/or loss. Name & Surname:PreviousNextSection 6: Managed Rights (Membership)Copyright and neighbouring rightsMembership Status: *ProvisionalMembership will be provisional until approved by Cosbots.Region or City (Residence): *Rights transferred to COSBOTS: *EconomicTerritories: *WorldPreviousNextSection 7: Next of Kin InformationFull Name & Surname: *ID / Passport Number: *Relationship: *Contact Number: *Next of Kin Address Details: *Address Line 1CityState / Province / RegionNext of Kin Details (Other):ID / Passport Number:Relationship:Contact Number:Next of Kin Address Details:Address Line 1CityState / Province / RegionPreviousNextSection 8: Inheritance InformationBeneficiary Full Name & Surname: *Address: *Address Line 1CityState / Province / RegionMobile Number: *Signature Clause: *I accept the following terms and conditionsI hereby apply to be admitted as a member of COSBOTS and declare that the above information is true to the best of my knowledge and that COSBOTS shall not be held accountable in case of any false information provided by myself. I understand that my membership is subject to the membership rules of COSBOTS, the COSBOTS Constitution and the Copyright and Neighbouring Rights Act, therefore my rights, obligations and liabilities as a member shall be governed by the above mentioned statutes, in Botswana.MessageSubmit