APRA AMCOS - Jingle Reporting Form

Need help?

Contact the APRA AMCOS office in your state.
Australian Members: writer@apra.com.au Website www.apraamcos.com.au
New Zealand members: nz@apra.com.au Website: www.apraamcos.co.nz

Section 1: Personal Details

* Required fields

* Name
Telephone
Fax
Mobile
* Email
Street
Suburb/Town
Post code
State

Section 2: Jingle Details

Period covered by this form

* Name of Product
* Song Title
* Work is (pick one)	Instrumental Original lyrics Agency lyrics
* Start date of campaign
* Advertiser/Sponsor
* Key Number
* Advertising agency
Australian contact person
Australian contact telephone
Overseas contact person
Overseas contact telephone

Section 3: Media Used

Tick as many as applicable -

Network TV
Local TV
Cable TV
Satellite TV
Radio

For local TV and radio, please specify broadcast areas and/or channels:

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'.

* Writer(s) full name (indicate publisher if relevant. Surnames in capitals: eg John SMITH)	* Contribution C = composer A = author CA = composer & author E = publisher	* Percentage share of royalties (must total 100%)	* Writer(s) IPI number

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

Other (please specify):

Territory specific requirements (if any):

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)

Competitrack code
Catalogue/CD/C number (if library music)
First air date
First line spoken or sung

I wish to include the following information with this submission:	Lead Sheet	Audio/Video/DVD of Broadcast
I wish to include the following performance reports with this submission:	Network TV	Cable TV

(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)

PRIVACY NOTICE

I have read and accept the terms of APRA AMCOS’ Privacy Policy (http://www.apraamcos.com.au/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
Email: writer@apra.com.au
Web: www.apraamcos.com.au

New Zealand Contact Information:
Unit 113, Zone 23, 21-23 Edwin Street, Mount Eden
Phone: 09 623 4717
Email: nz@apra.com.au
Web: www.apraamcos.co.nz

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