ACTIVITY REPORT Film 1

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1 Ref. Nr: Ref. Nr?? Original title : Local title : Date of first theatrical release: Number of cinemas during peak week Number of ELIGIBLE * screens during peak week Number of ELIGIBLE* Distribution Territory?? Number of cinemas "Maximum amount??" screens Final number of prints Optical DCP Other Digital Transfer INFORMATION ON THE RELEASE Number of VPF paid Total admissions Distribution Territory *A maximum of one screen per cinema can be declared. The screens must show the film minimum 2 times during the week declared. The screenings must be part of a commercial release where a normal ticket price is paid. Special events are excluded. Box Office (including VAT in EUR) Total: 0 Maximum amount requested Advertising costs (EUR) Promotion costs (EUR) Digital print costs (EUR) Optical print costs (EUR) Dubbing (EUR) Subtitling (EUR) VPF (EUR) TOTAL COST 0,00 Distribution's gross revenue (without VAT) Brief Description of the Theatrical Release Campaign. Dated on: "dd/mm/yyyy" Name of the authorised Signature of the authorised Name of the authorised legal representative? 1/7

2 Ref. Nr: Ref. Nr?? Original title : Local title : Date of first theatrical release: Number of cinemas during peak week Number of ELIGIBLE * screens during peak week Number of ELIGIBLE* Distribution Territory?? Number of cinemas "Maximum amount??" screens Final number of prints Optical DCP Other Digital Transfer INFORMATION ON THE RELEASE Number of VPF paid Total admissions Distribution Territory *A maximum of one screen per cinema can be declared. The screens must show the film minimum 2 times during the week declared. The screenings must be part of a commercial release where a normal ticket price is paid. Special events are excluded. Box Office (including VAT in EUR) Total: 0 Maximum amount requested Advertising costs (EUR) Promotion costs (EUR) Digital print costs (EUR) Optical print costs (EUR) Dubbing (EUR) Subtitling (EUR) VPF (EUR) TOTAL COST 0,00 Distribution's gross revenue (without VAT) Brief Description of the Theatrical Release Campaign. Dated on: "dd/mm/yyyy" Name of the authorised Signature of the authorised Name of the authorised legal representative? 2/7

3 Ref. Nr: Ref. Nr?? FINAL REPORT ON THE IMPLEMENTATION OF THE ACTION Date of first theatrical release: Peak Week from "date" to "date" Film title: PEAK WEEK: List of Cinemas Dates and numbers of screenings Admissions Number of sreenings per cinema and per day Date "date" "date" "date" "date" "date" "date" "date" Total Admissions: Screenings: Screens: Cinema Town day 1 day 2 day 3 day 4 day 5 day 6 day 7 0 "Cinema" name "Town name" "n of screenings" "n of admission" Total 0 3/7

4 Ref. Nr: Ref. Nr?? FINAL REPORT ON THE IMPLEMENTATION OF THE ACTION Date of first theatrical release: Peak Week from "date" to "date" Film title: PEAK WEEK: List of Cinemas Dates and numbers of screenings Admissions Number of sreenings per cinema and per day Date "date" "date" "date" "date" "date" "date" "date" Total Admissions: Screenings: Screens: Cinema Town day 1 day 2 day 3 day 4 day 5 day 6 day 7 0 "Cinema" name "Town name" "n of screenings" "n of admission" Total 0 4/7

5 FINAL REPORT ON THE IMPLEMENTATION OF THE ACTION Reference Nr: Reference Nr?? FINAL REPORT ON THE IMPLEMENTATION OF THE ACTION Distribution Territory Distribution Territory?? Maximum amount requested per Film of the package "Maximum amount??" "Maximum amount??" TOTAL AMOUNT REQUESTED 0 Number of Eligible Screens Number of ELIGIBLE*screens Number of ELIGIBLE*screens Name of the authorised Name of the authorised legal representative? Dated on: "dd/mm/yyyy" Signature of the authorised 5/7

6 Reference Nr: Reference Nr?? Ref. Nr: Ref. Nr?? RELEASE REPORT Annex IV - DI01 RELEASE REPORT FORM 1. PUBLICITY MATERIAL CHECK LIST Please supply this Release Report with publicity material concerning the film Publicity material (e.g. Posters, Photographs / Stills, Leaflets, Brochures, Press books, Slides, Merchandising) 2. INFORMATION CONCERNING THE FILM Original title of the film: Local title of the film: First date of release: 3. RELEASE FIRST WEEK Number of Cinemas Number of VPF Number of Admissions Box Office EUR 6/7

7 Reference Nr: Reference Nr?? Ref. Nr: Ref. Nr?? RELEASE REPORT Annex IV - DI01 RELEASE REPORT FORM 1. PUBLICITY MATERIAL CHECK LIST Please supply this Release Report with publicity material concerning the film Publicity material (e.g. Posters, Photographs / Stills, Leaflets, Brochures, Press books, Slides, Merchandising) 2. INFORMATION CONCERNING THE FILM Original title of the film: Local title of the film: First date of release: 3. RELEASE FIRST WEEK Number of Cinemas Number of VPF Number of Admissions Box Office EUR 7/7

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