If at any point you need assistance completing this form, please call us on 1300 852 388 or email firstname.lastname@example.org
All fields marked * are mandatory
AMCOS Reproduction Rights
If you have answered Yes to any of these questions the Station will be charged a Licence Fee for AMCOS under Schedule 3.
Net Simulcast/On Demand Streaming
If you have answered Yes to any of these questions the Station will be charged a Licence Fee for Net Simulcast/On Demand Streaming under Schedule 3.
Other Online Use
If you have answered Yes to any of these questions the Station will be charged a Licence Fee for Other Online Use under Schedule 3.
Category A Income
Sale of airtime & access fees
Subscriptions & memberships
Donations & bequests
Sale of programs
TOTAL GROSS INCOME
Category B Income
Grants & Subsidies
Category C Income
Sale of Capital Assets
Rental & Hire
Interest & Profit
Jobskills Wage Training Subsidy
Gross revenue from financial statement/audited accounts
If your revenue is more than $50,000:
Please email a copy of your audited accounts to email@example.com
The information contained in this document is signed by an authorised officer as true and correct:
The email address nominated on page 1 will receive a copy of this completed Schedule 5 on submission.