Item

Matter

 

Particulars

1

If the International Standard Serial Number in respect of the periodical publication is recorded in the periodical publication — that number.

 

 

2

If the International Standard Serial Number in respect of the publication is not so recorded — the name of the periodical publication.

 

 

3

The title or description of the article.

 

 

4

The name of the author of the article (if that name is known).

 

 

5

The volume, or volume and number, as the case requires, of the periodical publication containing the article.

 

 

6

The page numbers of the pages in that volume, or in that number of that volume, that have been communicated, or, in a case where a page so communicated does not bear a page number, such description of the page as will enable it to be identified.

 

 

7

The date on which the communication was made.

 

 

8

The number of persons to whom the communication was made.

 

 

9

The date on which this record is made.

 

 

 

 

 

 

 

 

 

(Signature)