(3)I do hereby relinquish my rights in the said work to the extent specified in the said statement:StatementDescription of the work:(a)Class of the work (Literary, Dramatic, Musical, Artistic, Cinematograph Film, Sound Recording).(b)Title of the work, if any;(c)Full name, address and nationality of the author;(d)Language of the work, if any;(e)Name, address and nationality of the publisher, if any;(f)Year of first publication, if any;(g)Country of first publication, if any;(h)If the copyright in the work is registered under section 45, the Registration member, if known.
