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Company info

*Company name

*Company office no

*Premises category

*Nature of business

Contact Person Details

Company Salutation*

*Company contact person

*Company contact person designation

*Contact person mobile no

*Email address

*Are you a member of any association?

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Tariff Details

*Music Commencement date

Premises Details
#	Premises Name	Address	State	Date	Type of Music Usage	Premises category	Action
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No	Type of documents	Filenames	Actions
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I/We acknowledge that I have read and understand the Terms And Conditions of Licence Agreement, Additional Terms And Conditions, Terms and Conditions of Use and Privacy Policy as stated herein.

I/We agreed that submission must be supported by a copy of invoice(s) or supporting documents for the purpose of verification of the Declaration by me/us.

I/We declare that the information in this quotation is correct.

Type electronic Signature

*Name (as per IC/Passport):

*Designation:

*Type of ID :

*ID No :

*Mobile Phone No:

*Email:

Date:

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