SECOND SCHEDULE (OPTICAL DISCS REGULATIONS 2000

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Malaysia Legislation

P.U.(A) 381/2000
OPTICAL DISCS REGULATIONS 2000

SECOND SCHEDULE

SECOND SCHEDULE

FORMS

(Regulation 3)

AKTA CAKERA OPTIK 2000
(OPTICAL DISCS ACT 2000)

PERATURAN-PERATURAN CAKERA OPTIK 2000
(OPTICAL DISCS REGULATIONS 2000)

BORANG/FORM ACO-1

Permohonan bagi Lesen Pengilangan dan Pembaharuan Lesen
Application for Manufacturing Licence and Renewal of Licence

Peraturan 5 dan Peraturan 7
(Regulations 5 and 7)

Pengawal Cakera Optik,
Controller Optical Discs,
Bahagian Penguatkuasa,
Enforcement Division,
Kementerian Perdagangan Dalam Negeri
dan Hal Ehwal Pengguna,
Ministry of Domestic Trade
and Consumer Affairs,
.................................................................................
.................................................................................

[Tandakan (a) dalam kotak yang berkenaan]
[Tick ( a ) in the appropriate box]

(a) Permohonan untuk Application for
(i) Lesen Pengilangan untuk: Manufacturing Licence for:
(A) Aktiviti Penyediaan Salinan Induk Mastering Activity
(B) Aktiviti Pereplikaan Replicating Activity
(b) Jenis permohonan Type of application
(i) Permohonan baru New application
(ii) Pembaharuan Renewal

NOTA:
NOTE

Jika ruang yang disediakan tidak mencukupi untuk memberi perincian, sila gunakan lampiran. Setiap lampiran hendaklah ditandatangani oleh pemohon.

(If the space provided is not sufficient to provide details, please attach annexure(s). Each annexure shall be signed by the applicant).

_________________________________________________
A. BUTIR-BUTIR PEMOHON
PARTICULARS OF APPLICANT
_________________________________________________

1. Nama pemohon dan alamat surat menyurat
Name of applicant and correspondence address
.............................................................................................................................................
.............................................................................................................................................

No.Telefon Telephone No.	: .....................	No. Telefaks Telefax No.	: .....................

Orang untuk dihubungi Contact person	: .....................	Jawatan Designation	: .....................

2. Nama dan alamat pejabat berdaftar
Name and address of registered office
.............................................................................................................................................
.............................................................................................................................................

No. Telefon : ..........................................
Telephone No.

No. Telefaks : ..........................................
Telefax No.

3. No. Pendaftaran : ..........................................
Registration No.

4. Alamat kilang
(Jika pemohon mengilang cakera optik di lebih daripada satu kilang, sila nyatakan setiap kilang itu)

Address of Factories
(Where the applicant manufactures optical discs at more than one factory, please specify each of the factories)
......................................................................................................................................................
......................................................................................................................................................

5. Alamat Stor
Address of Stores
......................................................................................................................................................
......................................................................................................................................................

6. Butir-butir Pengarah/Pekongsi
Particulars of Directors/Partners

Nama dan alamat kediaman Name and residential address	Warganegara Nationality	% saham dipegang dalam syarikat / % pekongsian % shares held in the company / % of partnership

_____________________________________________________________
B. BUTIR-BUTIR PENGILANGAN CAKERA OPTIK
PARTICULARS OF OPTICAL DISC MANUFACTURED
_____________________________________________________________

1. Keluaran
Product

Keluaran Products	Pengeluaran tahunan sebenar Actual annual production
	Kuantiti Quantity	Nilai di kilang Ex-factory value (RM)

2. Butir-Butir Saluran Pengeluaran
Production Lines Particulars

(a) Penyediaan Salinan Induk Mastering
Nombor Saluran Pengeluaran Production Line Number	Nama dan Nombor Model Mesin Pengilangan Name and Model Number of Manufacturing Machine	Kod Pengilang sedia ada Existing Manufacturer's Code

(b) Pereplikaan (termasuk acuan simpanan) Replications (including spare mould)
Nombor Saluran Pengeluaran Production Line Number	Nama dan Nombor Model Mesin Pengilangan Name and Model Number of Manufacturing Machine	Nombor Siri Acuan Mould Serial Number	Kod Pengilang sedia ada Existing Manufacture's Code

3. PASARAN
MARKET

Keluaran Products	% Pasaran % Market			Nama dan alamat pelanggan Name and address of clients
	Tahun 1 Year 1	Tahun 2 Year 2	Tahun 3 Year 3	Nama dan alamat pelanggan Name and address of clients
Untuk pasaran tempatan For Local Market Untuk pasaran eksport For export market

4. BAHAN MENTAH - POLIKARBONAT
RAW MATERIAL - POLYCARBONATE

SUMBER SOURCE
Pengilang Tempatan Local Manufacturer			Import Import
Nama dan alamat pembekal Name and address of supplier	Kuantiti setahun Quantity per annum	Nilai setahun Value per annum	Nama dan alamat pembekal Name and address of supplier	Kuantiti setahun Quantity per annum	Nilai setahun Value per annum

C. BUTIR-BUTIR LESEN/KELULUSAN DARIPADA AGENSI LAIN
DETAILS OF LICENCE/APPROVAL OF OTHER AGENCIES
(Sila sertakan salinannya)
(Please enclose copies)

Jenis Kelulusan Type of Approval	Rujukan Reference

1. Pihak Berkuasa Tempatan Local Authority	.....................................
2. Kebenaran di bawah Akta Penyelarasan Perindustrian 1975 Approval under The Industrial Co-ordination Act 1975	.....................................
3. Kebenaran di bawah Perintah Kastam (Larangan Mengenai Import) 1981 Approval under the Customs (Prohibition of Imports) Order 1981	.....................................
4. Kelulusan di bawah Akta Perbadanan Kemajuan Filem Nasional Malaysia 1981 Approval under the Perbadanan Kemajuan Filem Nasional Malaysia Act 1981	.....................................
5. ...........................................................................	.....................................

D. KEBENARAN DARIPADA TUAN PUNYA HAKCIPTA/PEMEGANG LESEN EKSKLUSIF
CONSENT FROM OWNER OF COPYRIGHT/EXCLUSIVE LICENSEE
(Sila sertakan salinannya)
(Please enclose copies)

E. PERAKUAN PEMOHON
APPLICANT'S DECLARATION

Saya mengaku dan mengesahkan bahawa semua maklumat dan butir-butir yang dinyatakan dalam borang ini dan salinan dokumen yang dilampirkan adalah benar.

I hereby declare that to the best of my knowledge and belief all the informations and the particulars stated in this form and the photocopies of documents annexed are true.

...................................................................
Tandatangan Pemohon & Meterai Perniagaan
Signature of Applicant & Business Seal

Nama/Name:...........................................................

No. Kad Pengenalan/Identity Card No. :
........................................................................

Tarikh/Date: ....................................................

Jawatan/Designation: ...........................................

F. UNTUK KEGUNAAN RASMI PEJABAT
FOR OFFICIAL USE

1. PENDAPAT
OPINION

Permohonan lengkap/tidak lengkap*
Application complete/not complete

Syor:
Recommendation:
...................................................................................................................................................................
...................................................................................................................................................................

* Potong mana yang tidak berkenaan
Delete whichever is not applicable

Tarikh/Date: ...................................................

...........................................................
Tandatangan Pegawai/Signature of Officer

Nama/Name: ....................................

2. KEPUTUSAN
DECISION

Permohonan diluluskan
Application approved

Permohonan ditolak
Application rejected

Tarikh/Date: .............................

....................................................................
Tandatangan Pengawal/Signature of Controller

Nama/Name: ............................................

3. KOD PENGILANG
MANUFACTURER'S CODE

(a) Penyediaan Salinan Induk Mastering
Nombor Saluran Pengeluaran Production Line Number	Nombor Model Mesin Pengilangan Model Number of Manufacturing Machine	Nombor Siri Acuan Mould Serial Number	Kod Pengilang Manufacturer's Code

(b) Pereplikaan (termasuk acuan simpanan) Replications (including spare mould)
Nombor Saluran Pengeluaran Production Line Number	Nombor Model Mesin Pengilangan Model Number of Manufacturing Machine	Nombor Siri Acuan Mould Serial Number	Kod Pengilang Manufacturer's Code

BORANG/FORM ACO-2

KEMENTERIAN PERDAGANGAN
DALAM NEGERI DAN HAL
EHWAL PENGGUNA

MINISTRY OF DOMESTIC

TRADE AND CONSUMER

AFFAIRS

AKTA CAKERA OPTIK 2000
(OPTICAL DISCS ACT 2000)

PERATURAN-PERATURAN CAKERA OPTIK 2000
(OPTICAL DISCS REGULATIONS 2000)

Peraturan 6
(Regulations 6) 000

LESEN PENGILANGAN CAKERA OPTIK
OPTICAL DISCS MANUFACTURING LICENCE

Lesen diberikan kepada: Licence is granted to	............................................. .............................................

Nama Perniagaan: Name of Business	............................................. .............................................

beralamat di: of	............................................. ............................................. ............................................. (Alamat Berdaftar/Registered Address)

untuk menjalankan pengilangan cakera optik dari ....................................................................................................
to manufacture optical discs from
hingga .................................................................................................................
to

tertakluk kepada peruntukan Akta Cakera Optik 2000 dan peraturan-peraturan yang dibuat di bawahnya, dan syarat-syarat yang dilampirkan bersama-
subject to the provisions of the Optical Discs Act 2000 and the regulations made thereunder, and the conditions attached herewith-

KOD PENGILANG
MANUFACTURER'S CODE

Amaun/Amount: RM

Resit No. /Receipt No:

Bertarikh pada ......................... hb. ......................... 20 .........................
Dated this ......................... day of............................. 20 .........................

...........................................
Pengawal Cakera Optik
Controller of Optical Discs