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फिल्म प्रमाणन अपीलीय न्यायाधिकरण Film Certification Appellate Tribunal

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Application Form for Filing Appeal

Application Form for Filing Appeal

(Under Section 5C of the Cinematograph Act)

The Secretary
Film Certification Appellate Tribunal
Room No. 970, Soochna Bhawan,
CGO Complex, Lodhi Road,
New Delhi-110 003
Sir/Madam,

Appeal under Section 5C of the Cinematograph Act, 1952, against the order of CBFC in respect of the long/short film

titled *

I. Appellant’s Details

1. (a) Full Name *

(b) Address *

(c) Email *

(d) Phone Number *

(e)Alternate Phone Number

(e) Appellant is the *

2. (a) Is the Appellant and the person who filed the application before the CBFC are same?

Yes No

(b) If the answer to the above is No, please give the name, address and telephone numbers of the person who filed application before CBFC.

Full Name *

Address *

Email *

Phone Number *

(e)Alternate Phone Number

3. (a) Is the Appeal filed within 30 days of the date of CBFC’s Order

Yes No

(b) if No, the reason as to why the appeal could not be filed within the prescribed period, as required under proviso to Section 5 C(1) of the Act.

(c) Condonation application attached

Yes No

(d) Condonation application attached file *

II. Film Details

1. Name of the Film *

2. Language of the Film *

3. Running time of the film as submitted to the CBFC *

4. Category of the Film

5.(a) Producer’s Name *

(b) Address *

(c) Phone Number *

6.(a) Director’s Name *

(b) Address *

(c) Phone Number *

7. State whether the film is

specify *

8. Certificate from CBFC

9. Certificate required for

10. Decision of the CBFC in brief.Reasons for refusal of the requested Certificate indicating the specific Rules or guidelines violated, as per orders of CBFC (Attach separate sheet, if needed).*

Certification Granted Certification Refused

11.CBFC Order No. against which appeal is being filed *

Date *

12.Grounds of Appeal

13. Undertaking- I undertake to make the film available for screening at the time of hearing of the appeal.Further I have no objection to the Appeal being heard by the Chairperson and one member of the Tribunal. Yes No

14.The Tribunal in its discretion upon the nature of the film and other relevant factor may direct the film to be heard personally in which case the exercise of option as above would not be applicable.

a. To be heard through Video conferencing

b. To be heard personally

c. Appeal to be decided on the basis of records.

III. Fee Submission Note:-

Fee of

(a) Rs. 100/- for films with length up to 2000 ft/72 mins.m

(b) Rs, 750/- for films with length more than 2000 ft/72 mins.

(a) Payment Date *

(b) Fee of Rs

(c) Receipt Number/Payment Reference *

(d) Attach Payment Receipt (Scan copy) *

IV. Submission of the Required Documents:

1. Film Synopsis *

2. Authenticated film script in the original language *

3. Translated portions including song of the film which are the subject
matter of excisions if any, to be attached.

4. CBFC’s order, appealed against. *

5.Affidavit as at Annexure. *Please see the FCAT format.

6. Declaration *

7. Any other document (Please specify)

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Last Updated on : 26-Feb-2021