FORM NO. 3A
APPLICATION FOR AN ADDRESS FOR SERVICE

1.I/We

2. Owner of Industrial Design

3. Apply for entry of

Date

4. Signature

Email

To the Registrar
Intellectual Property Office
Belize

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  1. Name of registered owner(s) or registered licensee(s).
  2. Insert Title of Industrial Design.
  3. State address for service.
  4. 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