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Piracy Report Form

If you would like to make a report about a person or company that is selling illegal music, please fill in the following report.

Please fill in as many fields as possible.

Name of Person/Company:

First Name:
Surname:

Home Address:

Address 1:
Address 2:
Address 3:
Address 4:
Telephone:
Mobile No.:
Fax No.:
Email:

If this person/company trades from a different address to the one above, please enter that address below:
Different Address:

Address 1:
Address 2:
Address 3:
Address 4:
Telephone:
Mobile No.:
Fax No.:
Email:

Product(s) being sold:

1.		2.
3.		4.
5.		6.

Music:
Type of Product i.e. CD, tape, etc.

Tape

Minidisc

Other

Artist(s)/Title(s)

1.	2.	3.
4.	5.	6.
7.	8.	9.

What made you suspect the products were pirated? Please enter details in the box below:

Method of sale:
Do they advertise?

Yes

If so, where?

Are you able to send us a copy of the advertisement?

Yes

Is it just by 'word of mouth'?

Yes

Is there a product list?

Yes

Would you be willing to assist us by making a test purchase?

Yes

About You
Information entered below is not compulsory. However, if you do decide to fill in your details, the information will be held in the strictest of confidence. We may need this information to contact you.

Your Name:

First Name:
Surname:

Your Address:

Address 1:
Address 2:
Address 3:
Address 4:
Telephone:
Mobile No.:
Fax No.:
Email:

Thank you!