Port Louis
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_________________
Please submit this Form (in triplicate) together with the appropriate fee.
Applicant's
or
Agent's
File
reference:…………………………………………………………………………………………
…
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_____________________
THE
APPLICANT(S)
REQUEST(S)
THAT
THE
ACCOMPANYING
INDUSTRIAL
DESIGN(S) BE REGISTERED:
______________________________________________________________________________
_____________________
1.
APPLICANT(S) (the data concerning each applicant must appear in this box or, if the
space is insufficient, in the supplemental box* at annex)
FULL NAME OF EACH
ADDRESS/TELEPHONE/
APPLICANT
FAX/E-MAIL
NATIONALITY
RESIDENCE
(underline surnames)
If
the
applicant
is
a
corporate
body,
give
the
Country/State
of
its
incorporation………………………………………………..….
………………………………………………………………………………………………………
………………………………………
2.
CREATOR