APPLICATION FOR AVAILING GRANT AID/FINANCIAL ASSISTANCE FOR PRODUCTION OF FILM BY GOAN FILM PRODUCERS 1 Whether Producer is (tick) Individual Partnership Limited Company Society 2 If Individual than Name of the Film Producer 3 Represented by (If the producer is not individual) Age in years: Sex (Tick) M F 4 Address Office Tel(O): Tel(M): Tel(R): (If not an individual then names and details of others and their respective holdings) 5 Registration Details (if not an individual) 6 Type of film proposed to be made (tick) Feature Non Feature If Non Feature (tick) Above 30 min below 30 min and above 10 min 7 Proposed Format (tick) 35mm 16mm HD DigiBeta Betacam DVC Pro 8 Duration of film Hrs: Min: 9 Have you produced any celluloid film or video film earlier (tick) Yes No In case of "Yes" give details of the film 10 Was your film censored Yes No 11 Has your film participated in any Film Festival (tick) Goan National International If Yes provide details 12 Has your film won any awards in the festival (tick) Yes No 13 Have you ever before availed subsidy for producing films from the Government of Goa or any Government agency (tick) Yes No If yes provide details 14 Name of the film you propose to produce for which you are applying for financial assistance 15 Whether the film is (tick) Original Remake Dubbed 16 Whether the film is based on any Novel then Title: Author's name: (enclose proof of the right acquisition of the written work on which the film is based) 17 Language (tick) Konkani Marathi English Hindi 18 Total cost in Rs 19 Amount of financial assistance required under the scheme 20 Details of expenditure on production of the film In the format provided as annexure 21 Details of balance amount to be raised by Film Producer 22 Name of Director Address: Tel (O): Tel (R): Sex (tick) M F (also attach his/her bio-data on separate sheet) 23 Name and addresses of following with bio-data a Story Writer b Screenplay writer c Lyrics writer d Dialogues writer e Music Director f Name of Choreographer if any g Director of photography h List of the main actors i Sound recordist j Editor (Please attach separate sheets with Biodata) 24 When do you propose to start with the shooting 25 Please enclose shooting schedule To be submitted later 26 Time required for shooting of the film 27 Time required for post production 28 When do you expect the film to get ready and duly censored Month: Year: 29 When do you expect the film to be released for public Month: Year: I/WE HEREBY DECLARE ALL THE INFORMATION PROVIDED IN THIS FORM IS CORRECT TO THE BEST OF MY/OUR KNOWLEDGE AND BELIEF AND NO PART OF IT IS FALSE (if the information given is found to be false the application may be rejected) Date Name & Signature of the Film Producer Seal DOCUMENTS TO BE ENCLOSED WITH APPLICATION FORM 1. Residence certificates or birth certificate of Producer/s, Director issued by competent authority. 2. Synopsis - Story 3. Screenplay 4. Bio-data of Story Writer 5. Bio-data of the Producer 6. Bio-data of the Director 7. Bio-data of the Music Director 8. Bio-data of the Director of Photography 9. List of the main actors. 10. Budget Summary. 11. Certificate of registration in case of Non Individual Producer 12. Income tax statements for the last 3 years 13. Affidavit stating that the producer will arrange the balance funds, has no criminal record and is not in default of any amount due to the State Government/ Government of India and that the script submitted does not violate the provisions of the Indian Copyright Act. BUDGET SUMMARY: Pre Production Fees in Rs 1 Location scouting 2 Permissions 3 Story, Screenplay, Dialogue & Lyrics 4 Research Director 6 Artistes (attach separate sheet with details) 7 Production Unit wages (attach separate sheet with details) 8 Music & Sound 9 Choreography Production Raw Stock/ Video tapes/ Memory cards/ Hard disk 11 Studio Rental 12 Equipment Rental 13 Travel & Transport 14 Location Expenses i) Accommodation : ii) Food : iii) Location Hire : Sets, Designing, Supervision, Construction, 16 Models and special properties 17 Costumes, Make-up materials and jewellery 18 Insurance of Production 19 Song Recording Visa Fees Post Production 21 Dubbing 22 Audio mixing 23 Laboratory charges 24 Digital Intermediate Visual/Special effects 26 Telecine and Reverse Telecine 27 Film stock/ Video tapes 28 Editing and post shooting 29 Recording and Re-recording 30 Publicity (Stills, Brochures, Posters) 31 Expenses for publicity, promotion and release of film 32 Expenses on Certification of Film 33 Miscellaneous Expenses 34 Unforeseen Expenses Date : Name of Applicant : Place : Signature : (SEAL) #
