Application Form For Accreditation: Fiscal Stamp

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REPUBLIC OF CAMEROON

MINISTRY OF COMMUNICATION
A PPL IC A TI ON F O R M F O R A C CR ED IT A TI O N

NO TE : Every column should be completed in CAPITAL LETTERS

1. NAME FISCAL STAMP


2. OTHER NAMES (MAIDEN NAME , PSEUDONAME, PREVIOUS NAME)

3. SURNAMÉ(S) 4. SEX (*) M F


5. DATE AND PLACE OF BIRTH D M Y
AT 6. COUNTRY

7. CURRENT NATIONALITY

8. PERSONAL ADRESS Fax number

9. CIVIL STATUS : (*) BACHELOR MARRIED SEPA RATED DIVORCED WI DOW(ER)

10. TYPE OFPASSEPORT OR TRAVEL DOCUMENT RECENT


(*) ORDINARY PASSEPORT ANY OTH ER DOC U ME NT (SPECIFY) PHOTOGRAPH
(1)
NUMBER ISSUING STATE OR ENTITY

ISSUE D ON D M Y AT EXPI RES ON D M Y

11. PROFESSION

12. EMPLOYER

13. ADRESS Fax number


RECENT
14. ELECTRONIC ADRESS PHOTOGRAPH
(2)

15. REPRESENTATIVE IN CAMEROON (person, organ or partner)


NAME, QUALITY
ADRESS, PHONE Fax number

OBLIGATORY REQUIREMENTS
OBLIGATOIREMENT :

+ A 1000 FCFA stamped application form, if need be, an invitation or a mission order issued by a partner based in
Cameroon ;
+ Two (2) recent passport-size photographs stapled on the application form ;
+ A photocopy of a valid passport ;
+ A document attesting membership to the profession of journalism or any other similar profession ;
+ A Public treasury receipt (5000 FCFA) ;
+ A hotel reservation or affidavit of support by a partner based in Cameroon;
+ A letter of invitation for the project;
+ Shooting (filming) plan specifying sites for coverage;
+ A list of professional equipment to be used (specifying the technical characteristics).

Given that this document is non-refundable, do not submit your passport(s), the originals of your
documents or any money.

N.B. These documents must get to the Ministry of Communication at least two (2) weeks before the date for the
begining of shooting.

Ministry of Communication
Web site : http://www.mincom.gov.cm
E-m ail : mincom _cm@ yahoo.fr
Tel.: (237) 223 30 22
Fax : (237) 223 30 22

DA TE AND SIG NA T UR E OF APPLICANT


(*) Tick the right answer

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