Adaption Clearance Request

Original title

Author and Composer

New title - if applicable

Genre of the new version

Duration of the new version

Name and address of the producer

Which publisher is the producer signed to

Collecting society and membership number

Name of the artist, project

Information about artist and producer- biography, discography, charted records

Record company

Name of Single- or Album release


Release date

In which territory will the record be released

Expected sales

Original sample usage yes or no

Length of the original sample

Sample loops, how often, length

Are there any other samples included. If yes, which?

Requester's name

Company including address