REPUBLIC OF ZAMBIA
Designs Form No. 1
Section 9
Regulation 3
THE REGISTERED DESIGNS ACT
Fee: 1 (a) or (c)
APPLICATION FOR REGISTRATION OF DESIGN (NON-CONVENTION)
Application is hereby made for registration of the accompanying design in the name of
(1)
(1) State full
name and
address of
applicant(s)
of
(2) Here state
the article to
which the
design is to be
applied as
shown in the
representations
who claim(s) to be the proprietor(s) thereof.
The design is to be applied to (2)
(3) The design has been previously registered for one or more other articles under
No. .........................................................................................
(4) The design consists of the design previously registered under No.
with modifications or variations not sufficient to alter the character or substantially to
affect the identity thereof.
Dated this
(3) and (4)
Delete one
or both
paragraphs,
if
inapplicable
day of .........................................., 19 ...............
(5)
My/Our address for service in Zambia:
(5) To be
signed by
the
applicant(s)
or his/their