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Page 1 of pages
• Complete all applicable spaces (numbers 7–9) on the reverse side of this page.
• See detailed instructions. • Sign the form at space 9.
Give the make and model of the vessel that embodies the design.
a: What is the type or style of the design for which registration is sought?
b: Provide a brief general statement setting forth the salient features of the design.
c: If this design is derived from an earlier design, describe how that design has been revised, adapted, or rearranged.
Provide the name and address of the designer(s). The name of the employer may be given instead of the designer(s) if (1) the design
was made within the regular scope of employment of the designer(s) and (2) the individual authorship of the design is difficult or
impossible to ascribe.
Please check here if those conditions are satisfied and you are providing the employer’s name.
Name: Name:
Address: Address:
If the owner is different from the designer(s) or employer named above, provide the name and address of the owner:
Name:
Address:
a: Was an application for registration of this design identified
in an application filed in a foreign country that extends to
designs of owners who are citizens of the United States, or
to persons filing applications in the United States, similar
protection to that afforded in 17 USC chapter 13?
 Yes No
Was this design made public before the date of application? Yes No
If yes, on what date?
Month Day Year
b: If yes, identify the country and date of application:
Country:
Date of application:
Serial no:
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OFFICE USE ONLY
application received
design copies received
funds received
Copyright Office fees are subject to change. For
current fees, check the Copyright Office website
at www.copyright.gov, write the Copyright Office,
or call (202) 707-3000 or 1-877-476-0778 (toll free).
Form D-VH
3
For Vessel Hull Design
UNITED STATES COPYRIGHT OFFICE
registration number
date of registration/publication
month day year
1
title
2
designer(s)
Check here if this
is a single design.
Check here if
registering more
than one design.
Use Form D-VH/
CON for additional
designs.
3
designer(s)
4
owner,
if not
designer(s)
5
priority
claim
6
date made
public
Privacy Act Notice: Sections 408-410 of title 17 of the United States Code
authorize the Copyright Office to collect the personally identifying informa-
tion requested on this form in order to process the application for copyright
registration. By providing this information you are agreeing to routine uses
of the information that include publication to give legal notice of your copy-
right claim as required by 17 U.S.C. §705. It will appear in the Office’s online
catalog. If you do not provide the information requested, registration may
be refused or delayed, and you may not be entitled to certain relief, remedies,
and benefits under the copyright law.
Provide the name and address of the person to whom correspondence regarding this application may be directed:
Name:
Address:
Email address:
FAX number: Daytime phone: ( )
Give the name and account number if the registration fee is to be charged to a deposit account established in the Copyright Office:
Name of account:
Account number:
declaration: The undersigned, as the applicant or the applicants duly appointed agent or representative, being hereby warned that
willful false statements are punishable by fine or imprisonment, or both, under 18 USC §1001, and that such willful false statements
may jeopardize the validity of this application or any resulting registration, hereby declares to the best of his or her knowledge and
belief:
(1) that the design has been fixed in a useful article;
(2) that the design is original and was created by the designer(s), or employer if applicable, named in the application;
(3) that those aspects of the design for which registration is sought are not protected by a design patent;
(4) that the design has not previously been registered on behalf of the applicant or applicant’s predecessor in title; and
(5) that the applicant is the person entitled to protection and to registration under chapter 13 of title 17, United States Code.
Complete if applicable:
The design has been made public with a design notice as prescribed by 17 USC §1306.
Following is the exact form of the design notice:
Where on the useful article is the design notice located?
If the undersigned is not the applicant, he or she is properly authorized to execute this application on behalf of the applicant.
signature date
print or type name position or title
telephone number fax number email address
examined by
checked by
correspondence
yes
FORM D-VH
for
copyright
office
use
only
name
number/street/apt
city/state/zip
17 USC §1327. Penalty for false representation. “Whoever knowingly makes a false representation materially affecting the rights obtainable under this chapter for the purpose of obtaining registration of
a design under this chapter shall pay a penalty of not less than $500 and not more than $1,000, and any rights or privileges that individual may have in the design under this chapter shall be forfeited.
Certificate
will be
mailed in
window
envelope
to this
address:
Copyright Office fees are subject to change. For current fees, check the Copyright Office website at www.copyright.gov, write the
Copyright Office, or call (202) 707-3000 or 1-877-476-0778 (toll free).
YOU MUST:
Complete all necessary spaces
Sign your application in space 9
SEND ALL 3 ELEMENTS IN THE SAME PACKAGE:
1 Application form
2 Nonrefundable filing fee in check or money order
payable to Register of Copyrights
3 Design material
MAIL TO:
Dept. D-VH
Vessel Hull Registration
PO Box 71380
Washington, DC 20024-1380
7
contact
person
8
deposit
account
9
certification
and sworn
statements
form dvh reviewed: 10/2012 Printed on recycled paper
u.s. government printing office:
2012-xxx-xxx xx,xxx
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET (FORM D-VH/CON).