Schedule – 4
(Related to Sub–rule (4) of the Rule 19)

……………………. Conservation Area
…………………… Conservation Office
Permit for Shooting a Cinema or Documentary Film
1. Name of the person/institution desiring to shoot or make a Cinema or
Documentary Film :
2. Address and citizenship of the person receiving the permit.
3. Four Boundaries of the Area allowed to shoot or make the Cinema or
Documentary Film :
4. The Duration (time period) provided to shoot or make the Cinema or
Documentary Film and fees:
5. Permit Receivers,–
Signature :– ………………………………………
Name, Surname :– ……………………………..
Age :– ……………………………..
Citizenship :– …………………..
Address : Permanent :– ……………………………..
Temporary :–……………………………..
Permit Issuing Officers,–
Signature : ………………………………..
Name, surname : ……………………….
Designation : …………………………….
Date : ……………………………………….