FORM NO. 3
APPLICATION FOR REGISTRATION OF A MARK

1. Application in respect of

2. In the name of

3. Address

4. Trading as

Email Address

Who claim(s) to be the proprietor(s) thereof.

5. Additional Matter

Date

6. Name of a Mark

7. Priority

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To the Registrar
Intellectual Property Office
Belize

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  1. Here specify the goods or services and give indication of classification under Nice Agreement (See link to Nice Classification on the QUICKMARK page).
  2. Here insert legibly the full name, description, nationality and residence of the applicant in whose trade or business address the individual, firm or body corporate is making the application. The names of all partners in a firm must be given in full. If the applicant is a body corporate, the kind and country of incorporation should be stated.
  3. Here insert the full trade or business address of the applicant.
  4. Here insert the trading style (if any).
  5. For additional matter if required; otherwise to be left blank, e.g. disclaimer, Use/Non-use Statement.
  6. Signature. 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.
  7. A claim to priority under section 56 of the Act should be made in this paragraph, (if applicable). Including date of filing in another country of the Paris Convention, number of convention application, name of country of filing convention application, and name of applicant in convention country (separate entries with commas). The applicant undertakes to furnish the Registrar with a certified copy of the priority application within 90 days from the date of this application.