REQUEST FOR AUDIO/VIDEO 
  Playback

To, Date : ___________
  The Secretary
Sangeet Natak Akademi
Rabindra Bhavan
New Delhi-110 001.

Name : (Mr./ Mrs./ Ms.) ___________________________________
Occupation ___________________________________
Address ___________________________________
  ___________________________________
  ___________________________________
Pin code __________
Phone No.(s) ___________________________________
 

                The following audio/video recordings may kindly be played back on _____________________
from ____________________ to____________________.

S.No. Subject Tape No.
     
Purpose :
Personal Reference/T.V. Film/Media/Study & Research
Any other ________________________________________________________________________
I agree to give due credit to Sangeet Natak Adademi for the use of above material.
Date: ________________   ____________________
Signature
DA/ADO   D.S (Docmn)
TO(R)/RE