This form must be completed by the individual or organization soliciting replication and not a broker or intermediary.
• Letters of Indemnity are not adequate.

• LICENSED content requires proof of licensing for replication.

• OWNED content indicates the individual/organization completing this form is the IPR owner.

Mark “YES” if you are the OWNER of the intellectual property rights of ALL the content on the disc.

If the answer is “NO”, you MUST PROVIDE PROOF OF LICENSING (permission from the actual owner of the content) before replication can begin.

Proceed to the section (1,2, or 3) below that applies to the content of your disc. MP3 or Enhanced Disc content requires completion of both ROM and Audio sections.
If you are not the IPR owner of ALL content on the disc, list on page two of this form or on a separate sheet all non-owned software, including freeware and shareware products (such as Acrobat Reader, Apple Quicktime, Internet Explorer, MS Powerpoint Viewer, etc.)

For any non-owned software, attach necessary distribution licensing documentation from the software vendor/publisher. (You should consult the software vendor for what is required)
Audio (CD or DVD) Content
A list of 1)TRACK TITLE, 2)ARTIST and 3)IPR OWNER (typically the performer or record label) for each track on the disc is REQUIRED for ALL audio titles, even if you own the content and performing rights for all recorded tracks.

If you are not the IPR owner (typically the performer or record label) of every track, you must provide proof of replication licensing from IPR owner.

Sampling/mixing of additional recordings not owned (regardless of type, quantity, and length) requires licensing of those original recordings.

“Cover versions” of songs written by someone other than the performing artist require proof of mechanical licensing or compulsory licensing.
Video (CD or DVD) Content
If you are not the IPR owner of the video content, proof of replication licensing from IPR owner is REQUIRED.

If there are audio tracks in the video that are separately licensed, complete Audio Section 2 above and provide necessary Audio/Video Synchronization licensing.
Anti-Piracy Compliance
I declare that all information provided herein is true and that all disc contents indicated as being "licensed" are properly licensed for replication under the terms of the original rights holder(s). I further declare that I am the intellectual property rights owner for all contents indicated as being "owned" and I authorize its duplication. I understand that in accordance with the Anti-Piracy Compliance Program procedures and standards of the International Recording Media Association (available at, the replicator reserves the right to refuse the processing of any order not complying with the Anti-Piracy Compliance Program guidelines.
Track Titles, Artist(s) & IPR owners
Please use the form below to:
Song/Chapter/File Name
List track titles, artist(s) and IPR owners for ALL tracks on audio discs
List chapter titles and any music titles used on Video discs
List all copyrighted software on CD or DVD ROM discs, including:
• software copyrighted by your company or the company that developed the CD for you
• any other executable (.exe) files not owned by you or your company (this includes applications by Microsoft, Apple, Intuit, Corel, Adobe, etc.
• any shareware or freeware executable (.exe) files on the disc (Acrobat Reader, Macromedia Flash, Apple Quicktime, Internet Explorer, Netscape Navigator)
If you are performing a ‘cover tune’, you probably own your own performance of that song (IPR), which is what this column is asking for. For ‘cover tunes’, you must provide mechanical licensing to perform the work from the publisher or from the Harry Fox Agency (

If you don’t have the rights to a performance (i.e., someone else owns the master recording), then you must obtain a license to include the performance on your disc and include proof of license agreement with your order.
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