NASCAM - Jukebox License Application

A. APPLICANT DETAILS

Surname

First Name

ID/Passport Number

Phone Number

Physical Address

Postal Address

Email Address

B. ESTABLISHMENT & JUKEBOX DETAILS

Establishment Name

Establishment Physical Address

Annual License Fee: N$500.00 per establishment

C. DECLARATION

I declare that the information provided is true and correct.

I understand this application is for a license to publicly perform musical works using a jukebox within NASCAM's repertoire.

Applicant Name

Signature

Date

D. PAYMENT INFORMATION

Banking Details:

Nedbank Namibia

Account Number: 11000017568

Branch Code: 461041 (Maerua Mall Branch)

Please use your full name as payment reference

Note: Proof of payment must be attached to this application form.

NASCAM JUKEBOX LICENSE APPLICATION