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Section 1: Your Personal Details

* Required Fields

Your Address
 

* Has your postal address changed since your last claim?

* Do you want APRA to confirm that we have received this form?

* Do you have any further evidence to accompany this submission?

*PLEASE NOTE:
TOUR SUPPORT PERFORMANCE/S (If applicable)
If any of the following dates are for performances where the performer/s were the support act for the headlining performer/s please complete the following:

Headline Performer:
Tour Name:
Performance Dates: From: - To:

Section 2: Venue details

Please take care to fill in ALL the fields in a row. Our current system does not allow us to validate this information. If there are insufficient fields for the amount of information you wish to enter, please submit this form multiple times.
Please make sure you write the date in the format of DD/MM/YYYY, for example 12/05/2017 including slashes ( / )

* Date of Performance dd/mm/yyyy * Venue Name * Venue Address * Venue Zip Code * Venue Country * Venue Phone Number * Capacity of Venue * Time of Performance * Cover Charge (Y/N) * Promoter's Name * Promoter's Contact No. * Promoter's Address
 

Section 3: Date of Performance

Important! Are your works registered? To ensure we can pay you, please enter registered works.

* Title of Work * Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/y yyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy		 Date
dd/mm/yyyy
 

PRIVACY NOTICE

I have read and accept the terms of APRA AMCOS’ Privacy Policy (www.apraamcos.com.au/privac)y and consent to the handling of my personal information as described in those terms.