(3) Here state
the set of
No. .........................................
articles, and
also
the trade
(5) The design consists of the design previously registered under No.
with modifications or variations not sufficient to alter the character or substantially to description of
each of the
affect the identity thereof.
articles
Application for protection of the design has been made in the following country
comprised in
(6)
the set, to
which the
on the following official date (7)
design is to be
numbered (8) Such application was the first application
applied as
made in a convention country in respect of the relevant design, whether by the
shown in the
applicant(s) or by any person of whom he/they claim(s) to be the legal representative(s) representations
or assignee(s), and the applicant(s) in the above mentioned country qualify/qualifies
under (9) Article 2/3 of the Convention by reason of being (9) a national(s)
of/domiciled in/having a place of
(4) The design has been previously registered for one or more other articles under
business in a member state, namely
This application is made on the ground that I/we qualify under the said (9) Article 2/3 by
reason of being (9) a national(s) of/domiciled in/having a place of business in a member
state, namely
and that to the best of my/our knowledge and belief there is no lawful ground of objection
to the registration of the design and that I/we request that the design may be registered as
of the date (7)
Dated this
day of .........................................., 19 ...............
(4) and (5)
Delete one
or both
paragraphs,
if
inapplicable
(6) Here
insert the
name of the
convention
My/Our address for service in Zambia:
country in
which the
first
application
was made
The Registrar,
(7) Here
The Designs Office,
insert the
Lusaka,
official
Zambia.
date of the
NOTE.-Four identical representations or specimens of the design should accompanying
first
this form, and, except in the case of an application in respect of a design to be applied to a application
textile article, to wallpaper or to lace, it should further be accompanied by a statement of in a
the features of the design for which novelty is claimed.
convention
country
(10)