Form IV-A

PART II
Particulars of excisions and modifications :

Form IV-A
( See Rule 35(1)
GOVERNMENT OF INDIA
CENTRAL BOARD OF FILM CERTIFICATION
THIS CERTIFICATE IS VALID FOR VIDEO FILMS ONLY
Part I

CERTIFICATE NO. DATED CATEGORY “V/U”
FILM GAUGE MM LENGTH MTS REELS

After examination of the film by the members of the Examining Committe/ Revising Committee/ Film Certification Appellate Tribunal mentioned below and on the recommendations of the said Examining Committee/ Revising Committee/ Film Certification Appellate Tribunal, the Board hereby certifies that the film is fit for unrestricted public exhibition subject to excisions and modifications listed in Part II on the reverse :-

UNIVERSAL VIDEO

Further certified that the excisions and modifications imposed by the Board have actually been carried out.

Name of the applicant

Name of the Producer
  CHAIRMAN