DECLARATION FORM FOR LITERARY WORKS,
MONOLOGUES AND SKETCHES*
TITLE: …………………………………………………………………………………………..……………………………..…….............................................
SUBTITLE: …………………………………………….....………………………………………….…………………………..……….….................................
IF IT REGARDS A TRANSLATION, ORIGINAL TITLE: .......................................................................................................................
EXCERPT FROM (COLLECTION, ANTHOLOGY...): .....................................................................................................................
GENRE:
r poetry
r literature
r theâtre
r text
r Sketch
r educational text
r scientific text
DURATION: ………….MIN. (SKETCHES AND MONOLOGUES)
r IT REGARDS A NEW DECLARATION
r THIS DECLARATION REPLACES THE DECLARATION NUMBER ……..…………. ON …../..…../..……..
Name and First Name(s)
IP Name number
Signature(s)
AUTHOR(S)
TRANSLATOR(S)
IF YOU HAVE WRITTEN A SKETCH WITH MUSICAL WORKS INSERTED IN IT, WE REQUEST YOU TO ENCLOSE IN THIS
DOCUMENT THE LIST OF THESE WORKS (+ NAMES OF THE COMPOSERS / LYRICISTS).
Drawn up in ...........................................on........................................
The data that you provide to us will be dealt with in our processing "Registration and administration of the associate members with a view to the management of the author’s
rights". The controller of the file is the civil society with limited liability SABAM, located at 75-77 rue d'Arlon, in 1040 Brussels. In accordance with the law of December 8,
1992, you have a right of access and rectification. For further information, see the public register mentioned in article 18 of the law.
* If all right owners are members of SABAM, you can make your declarations online by using the OWR application on
our website
Reserved to SABAM:
Registration number
Class. ......... P.
sent back / retrieved on ..... / ..... / ...........
DOCUMENTATION DEPARTMENT
> Rue d’Arlon / Aarlenstraat 75-77 - 1040 Brussels > Tel : + 32 2 286 82 11 > Fax : + 32 2 280 38 57
> e-mail : contact@sabam.be > www.sabam.be > BTW/TVA : BE 0402.989.270 > RPR/RPM Brussel/Bruxelles
17E
HOW TO FILL IN THE DECLARATION FORM?
TITLE
We recommend you not to use the same title or subtitle for the works of the same right owner(s) in order to avoid
distribution errors that occur for instance because the programmes are incomplete.
IF IT REGARDS A TRANSLATION, ORIGINAL TITLE
If you have made a translation, you can indicate here the original work’s title. Moreover, the name of the original
work’s writer has to be indicated in the table’s box meant for “author(s)”. You can mention your own name in the
box “translator(s)”.
EXCERPT FROM
You can mention here the name of the anthology, collection, etc., containing the work in question. Poetry collections
are preferably declared in their entireness. In this case, it is sufficient to fill in one single declaration form, on
which you indicate the collection’s title. Do not forget to add a list of the poems featured.
DURATION
This box is only important for sketches and monologues. There has the duration of the spoken text to be indicated.
To be perfectly clear: if your sketch or monologue is performed on stage, our services will base themselves on the
performance’s duration.
NAME AND FIRST NAME(S)
The names and first names of all the authors and translators must be indicated even if they are not affiliated to
SABAM or another authors’ society. (For the translations: see 2.) Please see to the correct spelling of the names,
first names and pseudonyms. If you wish to declare a work under your pseudonym, it is necessary to mention it on
your declaration form.
IP NAME NUMBER
The IP Name Number is an international number that is allocated to each member of an author’s society and to all
his pseudonyms. With this number, each right owner can be identified. If you don’t know your number*, you can
mention next to your name your other first names.
SIGNATURE(S)
All persons who are involved in the work must sign the declaration form, including if need be the heirs’ representatives. This is also valid for the unaffiliated persons or the members of other authors’ societies. If you have translated a work, it is not necessary to have this form signed by the author of the original work. It is enough that you
enclose the written authorization (or a copy thereof) of the original author or publisher.