FORM NO. 2
FORM OF AUTHORISATION OF AGENT IN A MATTER OR PROCEEDING UNDER THE ACT

(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 a trade mark agent)

1. I/ We

2. Have appointed

3. To act as my/our agent for

And request that all notices, requisitions and communications relating thereto be sent to the agent at the above address.

_______________________________________________________________________________________________

I/We hereby revoke all previous authorisations, if any, in respect of the same matter or proceeding.

4. Nationality

2. Authorize

To request the entry of an address for service as part of any registration obtained under the above authorization.

Date

5. Signature

Email (required)

6. Address

To the Registrar
Intellectual Property Office
Belize

--------------------------------------------------------------------------------------------------------------------------------------------------------------------

  1. The full name of all the partners in a firm must be inserted, and the kind and country of incorporation of bodies corporate stated (separate multiple entries with commas).
  2. Here insert name and address of agent.
  3. Here state the particular matter or proceeding for which the agent is appointed giving the reference number, if known.
    Here state nationality.
  4. To be signed by the person appointing the agent. 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. 5 of 2005). An applicant must notify the Office of his particular method of electronic signature.
  5. Here insert the full trade or business address of the person appointing the agent (To be omitted if the person appointing the agent desires his own address to be treated as the address for service after registration)