INDIAN PANORAMA ENTRY FORM
1.(a) Script Type:		Select Roman Devnagri
(c) English translation of the title:
(d) Title of the film in the script of the language of the Film:
d. Demand Draft No.:		Demand Draft Date:
e. Bank on which the DD is drawn:		Select SBI PNB Allahabad
Amount:
2. Language of the Film:	Select Eng./Guj./Hin. Bengali] English Hind Manipuri Kannada [Hindi] Oriya Malayalam Hindi/Mal. & Eng. [Marathi] Urdu/Hindi Monpa [Bengali] Music Bodo [Tulu] Music only Silent Varhadi- Marwari Haryanavi Punjab Punjabi Bhojpuri Eng./Mal. Hindi/English [Kannada] Eng./Guj. Tamil Malayalam] Col. Bengali Baujpuri Hindi] [English] Hindi/Urdu Konkani Hindi/Marathi Hindi/Eng. English/Hindi Hindi & English No Text Telugu Gujarati Mal. & Eng. Hindi English & Urdu) Silence Mal. Malyalam Hindi/Bengali Eng./Hindi Sanskrit Kannada/Eng Kokborok EST [Rajasthani] Khasi Marathi Karbi Mizo Assamese Hin./Punjabi Kanada English/Mizo NAGAMESE Hindi/punjabi	(Whether subtitled in English language)	Yes No
3. Width of the film : ( only in case of Non Feature Film category)		70 mm 35 mm 16 mm Video format
4. Producer Company Registration Details Title Registration Details: Company Name : Email : Address : Country : Select India USA Cannada Russia France Germany Paris Pakistan Bhutan Turkey State : Select ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHHATTISGARH DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU AND KASHMIR Mumbai Mizoram Tamil Nadu Uttar Pradesh MAHARASHTRA Karnataka City : Mobile : Postal Code : Phone : Fax : IsRegister : Yes No RegistrationNo :
4.1 Whether the company is registered as an Indian entity : (In accordance with Clause 6.2.2)		Yes NO
4.2 Whether an Indian citizen :		Yes NO
5 Producer Contact Detail Title : Select Mr Mrs Miss Dr M/s First Name : Last Name : Address : Email : Country : Select India USA Cannada Russia France Germany Paris Pakistan Bhutan Turkey State : Select ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHHATTISGARH DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU AND KASHMIR Mumbai Mizoram Tamil Nadu Uttar Pradesh MAHARASHTRA Karnataka City : Mobile : Postal Code : Phone : Fax :
5.2 In the case of a co-production
CO-Producer Contact Detail Title : Select Mr Mrs Miss Dr M/s Indian Partner First Name : Indian Partner Last Name : Indian Partner Address : Email : Country : Select India USA Cannada Russia France Germany Paris Pakistan Bhutan Turkey State : Select ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHHATTISGARH DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU AND KASHMIR Mumbai Mizoram Tamil Nadu Uttar Pradesh MAHARASHTRA Karnataka City : Mobile : Postal Code : Phone : Fax :
Director Contact Detail Title : Select Mr Mrs Miss Dr M/s First Name : Last Name : Address : Email : Country : Select India USA Cannada Russia France Germany Paris Pakistan Bhutan Turkey State : Select ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHHATTISGARH DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU AND KASHMIR Mumbai Mizoram Tamil Nadu Uttar Pradesh MAHARASHTRA Karnataka City : Mobile : Postal Code : Phone : Fax :
7. Author of the Story:
8. Screenplay writer:
9. Director of Photography:
10. Editor:
11. Art Director:
12. Costume Designer:
13. Director of Music:
14. (a) Sound Recordist:
(b) Sound Rerecordist :
15. Principal Cast:
16. Length (in meters) (In case of film formats):
17. Running time (in minutes ):
18. Number of Reels/Tapes:
19. Print:		B & W Color
20. Sound System:		optical Mono Dolby DTS others
21. Screen Ratio:
10. CBFC Certificate No. :		Date of Certification:
23. Value of the Print:
23.1 Print Return To Contact Detail Title : Select Mr Mrs Miss Dr M/s First Name : Last Name : Address : Email : Country : Select India USA Cannada Russia France Germany Paris Pakistan Bhutan Turkey State : Select ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHHATTISGARH DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU AND KASHMIR Mumbai Mizoram Tamil Nadu Uttar Pradesh MAHARASHTRA Karnataka City : Mobile : Postal Code : Phone : Fax :
24. Print of the film to be returned to:
Airport Destination:
6 Exporter Contact Detail Title : Select Mr Mrs Miss Dr M/s First Name : Last Name : Address : Email : Country : Select India USA Cannada Russia France Germany Paris Pakistan Bhutan Turkey State : Select ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHHATTISGARH DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU AND KASHMIR Mumbai Mizoram Tamil Nadu Uttar Pradesh MAHARASHTRA Karnataka City : Mobile : Postal Code : Phone : Fax :
Foreign Right Holder Contact Detail Title : Select Mr Mrs Miss Dr M/s First Name : Last Name : Address : Email : Country : Select India USA Cannada Russia France Germany Paris Pakistan Bhutan Turkey State : Select ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHHATTISGARH DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU AND KASHMIR Mumbai Mizoram Tamil Nadu Uttar Pradesh MAHARASHTRA Karnataka City : Mobile : Postal Code : Phone : Fax :