Public Video Screening Licence | Quarterly Reporting Form

Licence Holder Information

Name of Licensed Premises *

PVSL Account Reference No.

Address

Your Name *

Telephone *

Email *

Please list ALL films screened during this period *

I hereby declare that to the best of my knowledge and belief that this is a true, accurate and complete list of the films which have been screened under the PVSL at the premises indicated, for this reporting period. I accept and agree that the data submitted by me in this form will be used by Filmbankmedia in accordance with the PVSL terms and conditions and the Privacy Policy (available on the link below). *

We would like to keep you informed via email of any updates, changes and promotions relating to the PVSL and Filmbankmedia. Please tick the button if you would prefer not to receive these communications.

Please tick to continue *

Licence Holder Information

Terms and Conditions | Public Video Screening Licence