Form V

PART II
Particulars of excisions and modifications :

Form V
( See Rule 35(1)
GOVERNMENT OF INDIA
CENTRAL BOARD OF FILM CERTIFICATION
THIS CERTIFICATE IS VALID FOR THEATRICAL RELEASE ONLY
Part I

CERTIFICATE NO. DATED CATEGORY “A”
FILM GAUGE MM LENGTH MTS REELS

After examination of the film by the members of the Examining Committe/ Revising Committee/ Film Certification Appellate Tribunal mentioned below and on the recommendations of the said Examining Committee/ Revising Committee/ Film Certification Appellate Tribunal, the Board hereby certifies that the film is fit for public exhibition, restricted to adults only, subject to excisions and modifications listed in Part II on the reverse :-

ADULTS ONLY

Further certified that the excisions and modifications imposed by the Board have actually been carried out.

Name of the applicant

Name of the Producer
  CHAIRMAN