Form of Declaration

Form I (See rule 3). I, ....................., declare that I am the printer or publisher or printer and publisher of the newspaper named ....................., which will be printed/published at ..................... or printed and published at ...................... The particulars regarding the said newspaper, which are given below, are in accordance with my best knowledge and belief: 1. Name of the newspaper. 2. Languages in which the newspaper is published. 3. Periodicity of publication of the newspaper: (a) Whether daily, bi-weekly, tri-weekly, weekly, fortnightly, monthly or any other periodicity. (b) In case of a daily, please mention whether it is a morning or evening newspaper. (c) In case of daily newspaper and all other newspapers, please mention the date(s) on which it is published. 4. Retail selling price of each copy of the newspaper: (a) If the newspaper is for free distribution please mention "for free distribution". (b) If it has only annual subscription and no retail price, please mention the annual subscription. 5. Name of the publisher: Nationality: Address: 6. Place of publication (please give full address). 7. Name of the printer: Nationality: Address: 8. Name of the printing press(es) where printing is to be done and the exact and brief description of the premises where the printing press(es) is/are located. 9. Name of the editor: Nationality: Address: 10. Owner(s) of the newspaper: (a) Please give the details of the individual(s), or firm, joint stock company, trust, cooperative society or association who is/are the owner(s) of the newspaper. (b) Please mention whether the owner is also the owner of any other newspaper and if so, give the name of such newspaper, periodicity of publication, language and place of publication. 11. Please mention whether the declaration: (a) is in respect of a new newspaper; (b) is in respect of an existing newspaper; (c) if the declaration comes under item (b), give the reason for filing a fresh declaration. Signature. Name (in block letters). Date.