DOGME CERTIFICATE FORMULA | Dogme95.dk - A tribute to the official Dogme95

Original title:……………………………………………………………………………………………………………..

Title in English:………………………………………………………………………………………………………….

Nationality:………………………………………………………………………………………………………….

Sworn statement
In regard to my feature film “……………………………………………..” I hereby solemnly swear that
I have adhered in full to the Dogme95 Manifesto and the Vow of Chastity. I thus request
that a dogme certificate be issued and forwarded.

……………………………………………………………….
Director’s signature

……………………………………………..
Date:

……………………………………………..
Place

Production Company:
(Name/address/phone/fax/E-mail)

Foreign sales representative:
(Name/address/phone/fax/E-mail)

Director:

Screenplay & Dialogue:

Director of Photography:

Producer:

Main Cast: Name of the Part:
……………………………………………………………. = ………………………………………………………………………………………………
……………………………………………………………. = ………………………………………………………………………………………………
……………………………………………………………. = ………………………………………………………………………………………………
Budget in US dollars:

Length in minutes:

By this I confirm my willingness to pay Danish Kroner 10.000,- for the Dogme95 Certificate.

……………………………………………………………………………….
(Director’s signature)

Since this feature film has a fair- to high budget I volunteer to pay Danish Kroner 30.000.- for the Dogme95 Certificate.

……………………………………………………………………………….
(Director’s signature)

By this I ask for an annulment of the demand for a payment of Danish Kroner 10.000,-.
(Please state your reasons for an annulment):

……………………………………………………………………………………………………………………………………………………..

……………………………………………………………………………….
(Director’s signature)

When I have finished the film and recieved the Dogme certificate I agree to send a VHS-copy of the film
(preferably with english subtitles) to the Dogme Secretariat to be filed in the Dogme archives.

……………………………………………………………………………….
(Director’s signature)

Send to: Nimbus Film, Dogme Secretariat, Avedoere Tvaervej 10, DK-2650 Hvidovre, Denmark.