FORM III
(See rule 33)
(To be submitted in duplicate)

(Report under rule 33 of the Cinematograph (Certifications Rules, 1983 regarding an alteration or alterations in a certified film. ) ....................................................................

1. Name of the applicant :
2. Name of the film :
3. Certificate No.
   Dated :
4. Particulars of alterations :
   

   Reel No.	Scene No.	Description of the scene/dialogue/song
   length

In the case of video films, instead of length and number of reels, duration in minutes and number of cassettes may be given.
(Specify the exact alteration or alterations, length and the number of the reel or reels in which the alteration or alterations occurs or occur)

To
The Chairman, Central Board of Film Certification Through the Regional Officer
at Bombay/Calcutta/Madras .............................................................................................

I declare that the above particulars are true in every respect and are full description of the alteration or alternations made in the film after its certification.

Signature of Applicant

Date :

Address :

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(Form II-A added by G.S.R. 83-E dated 28.2.84 w.e.f. 1.3.84)
^* Score out the word or words which are not applicable.
^** Added by GSR 83 (E) dated 28.4.84 w.e.f. 1.3.84
¹. As per notification dated 12.11.97