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Rightsholder notification form

For the purposes of proper and effective exercise of collective management of rights in accordance
with Act No. 185/2015 Coll. on copyright and rights related to copyright including distribution of royalties and remuneration, a rightsholder reports to LITA/notifies LITA on all the necessary data. Rightsholder is obliged to fill in this form upon first reporting of his work or its use and each time his or her personal details change.

Rightsholder details:

*first name::

*last name::

Title before name:

Maiden name:

Title after name:

Pseudonym:

Pseudonym is public:

Yes No

*Date of birth:

Place of birth:

Business ID:

Nationality:

Tax ID:

*Gender:

VAT ID:

*Tel. No.:

*Tax residency:

*E-mail address 1:

(country in which the taxpayer pays taxes)
We ask you to send your tax residency to LITA if you have tax domicile other than Slovakia (the document is issued by the tax office on request).

*Rewards I ask :

to tax not to tax(Applies only to authors who have taxable income in Slovakia, must sign an agreement on non-taxable income below)

E-mail address 2:

Web:

Rightsholder permanent address:

*Street and number:

*City:

*zip code:

*state:

For Slovakia, enter the zip code in numeric format without spaces, e.g. 12345. For other countries, use the local format.

Contact address if different from permanent address:

Street and number:

City:

zip code:

state:

For Slovakia, enter the zip code in numeric format without spaces, e.g. 12345. For other countries, use the local format.

*I want to have my royalties sent to:

Permanent address via postal order

Contact address via postal order if it is different from my permanent address

to the following bank account

IBAN:

SWIFT/BIC:

bank name:

bank address: