FORM NO. 3
APPOINTMENT OF AGENT

(This form is only required for an applicant whose residence or principal place of business is outside Belize or for a local applicant applying through an attorney)

I/ We

1. Appoints

2. In respect of

Empowers the appointed agent to sign and amend the application, to prosecute it, to receive the registration certificate, to effect renewal, and to withdraw or surrender the application or registration, and ratify any act done by the appointee in respect of the application or subsequent registration.

Date

Place

5. Signature

Email

To the Registrar
Intellectual Property Office
Belize

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  1. Name and address of agent.
  2. Title of Industrial Design. State whether appointment is general or specific.
  3. The application may be signed by printing, completing and faxing or attaching the FACSIMILE SIGNATURE FORM, or using any combination of letters, numbers, spaces or punctuation marks placed between two forward slash (“/”) symbols. Examples of acceptable password signatures for electronic application forms include /ramses/, /drl/, and /577-34567/ (Section 9 of CAP. 290:01 read with Paragraph 2 of A.I. No. 8 of 2006). An applicant must notify the Office of his particular method of electronic signature.