OFFICIAL GAZETI'E - GOVT. OF GOA SERIES I No. 50 (EXTRAORDINARY) 22ND MARCH, 2006 SCHEDULE II (See Clause 6) Department of Information & Publicity Government of Goa APPLICATION FOR AVAILING GRANT IN AID/ FINANCIAL ASSISTANCE FOR PRODUCTION OF FILMS BY GOAN PRODUCERS 1. Name of the producer ............................................ .............................. ..................... Age ..............................................Sex ............................. 2. Address Office: .................................................................................. ................... ........... .................................................... Tel: ................................. Residence: ......................................................Tel: ............................. ......... 3. Rep. by .............................................................. ................................................. 4. Registration code no -with Department of Information .......................................................... . 5. Whether Individual/Partnership/Ltd. CO. /Society............................................... 6. Type of film you propose to make : Feature/Short Film Documentary 7. In what format will it be filmed digital/Betacam/Digi-beta/celluloid etc... .................................. .... . 8. Duration of film: .........................Hrs. ............. Min...... ..........Sec. 9. Have you produced any celluloid film or video film earlier: 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 Goan/National/ International Film Festival: Yes/No ..................... . In case of "yes" give details ....................................................................... 12. Has your film won any awards in the festival: Yes/No:............. If "yes" give details.............. 13. Have you ever before availed subsidy for producing films from the Government of Goa or any Government agency: Yes/No if "yes" give details .......................... ................................ 14. Name of the film you propose to produce for which you are applying for financial assistance: ...................................... 15. Whether the film is Original/Remake/Dubbed: .................. . 16. Whether the film is based on any Novel then Title 8t Author's name ............................................ . 17. Language of the film: ......................................................................... 18. Total cost of the film: ............................................................................................ 19. Amount of financial assistance applying for production of the film: ................................ ........ . (Attach separate sheet giving details.) 20. Details of expenditure you are 'going to incur for production of the film: ................................... (Attach separate Sheet) 21. Details of balance amount to be raised by producer ............................................................. OFFICIAL GAZE'ITE - GOVT. OF GOA SERIES I No. 50 {EXTRAORDINARY} 22ND MARCH, 2006 22. Name of Director who will be directing your film and his/her address: ...... ........................ (also attach his/her bio-data on separate sheet) 23. Name and addresses of following with bio-data 1.Name of the Story Writer .................................................. ..................... ....... 2.Name of the Screenplay writer ........................................... .................... ....... ... . . 3.Name of Lyrics writer .................. : .................................... ..................... ...... .. . 4.Name of Dialogues writer ........... ...................................... ..................... ......: . 5. Name of Music Director ............................................................ 6. How many songs you propose to include in the film:........ 7. Name of Choreographer if any: ............................................................................ . 8.Name of Director of photography: ........................................................ , .............. . 9. List of the main actors with their character name in the film........ .......... 24.When do you propose to start with the shooting: ............ .............................................. . Please enclose shooting schedule. 25. Time required for shooting of the film: ....................................................................... 26. Time required for post production: .......................................................................... . 27. When do you expect the film to be release for public : ................................................... 28. When db you expect the film to get ready and duly censored: Month: ...................... year ....... . 29. Within how many months you expect to complete the film from the date of receipt of first installment: I/WE HEREBY DECLARE THAT WHATEVER 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 shall be rejected) Date: ............................ . ................................................. ~~ Signature of the Producer Seal CHECK LIST OF DOCUMENTS ENCLOSED WITI:I APPLICATION FORM 1. Synopsis -Story 2. Screenplay 3. Bio-data of Story Writer 4. Bio-data of the Producer 5. Bio-data of the Director 6. Bio-data of the Music Director 7. Bio-data of the Director of Photography 8. Bio-data of the Editor 9. Bio-data of the Lyricist 10. Bio-data of the Art Director 11. Projected expenditure
