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Australian Members: Website
New Zealand members: Website:

Section 1: Personal Details

* Required fields

Section 2: Jingle Details

Period covered by this form

* Work is (pick one)

Section 3: Media Used

Tick as many as applicable -

Section 4: Jingle Ownership Details

Please list the names and contributions of all authors/composers involved in creating this jingle. For example, if lyrics are included with this jingle and you did not write the lyrics, then please give us the author's name below or, where relevant, write 'agency lyrics'.


Section 5: Territories where the jingle is likely to be broadcast

Note: some of the territories shown below do not distribute for jingle performances. Please check as many as applicable

  1. (if you clicked USA then you need to complete section 6 before you send)

Section 6: Information required by ASCAP

Complete only if jingle was broadcast in the USA
(All below information is required for broadcasts in the United States by ASCAP)

I wish to include the following information with this submission:
I wish to include the following performance reports with this submission:

(Please do not send through your evidence upon submitting this form as an APRA AMCOS Writer Services Representative will be in contact with you to organise the receipt of your material)


I have read and accept the terms of APRA AMCOS’ Privacy Policy ( and consent to the handling of my personal information as described in those terms.

Australian Contact Information :
16 Mountain Street, Ultimo NSW 2007
Phone: 02 9935 7900
Fax: 02 9935 7970

New Zealand Contact Information:
Unit 113, Zone 23, 21-23 Edwin Street, Mount Eden
Phone: 09 623 4717

APRA AMCOS has five offices in Australia and an office in New Zealand. Click here for further contact details for your area.