FORM NOS. 1/2
APPLICATION FOR REGISTRATION OF AN INDUSTRIAL DESIGN/ STATEMENT OF DESIGNER

I/We

Address

1. Applies for registration of

2. Address for service

3. Agent

4. Creator of design

5. Priority

6. Class and name of product

7. Description

8. Specimen

Date

Place

9. Signature

Your Email (required)

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  1. State kind of product.
  2. If different from address given above.
  3. If applicable. State name and address of agent.
  4. State name and address of creator. Complete only if applicant is declaring that he created the Industrial Design, and requesting that his name be entered on the Register under section 4(6) of the Act.
  5. Indicate date and number of earlier application(s), the country where filed, and the name of the applicant(s) of the priority application(s). Submit within ninety days of the date of this application a certified copy of the earlier application(s) on which priority is based.
  6. Complete only if applicable.
  7. Give a short description of the visual features of the design, indicating what parts of it are original.
  8. Check box if specimen is supplied.
  9. The application may be signed by printing, completing and faxing or emailing 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.