(a)

(a)

Applicant is the creator:

(b)

(b)

If the applicant is not the Creator:

Yes

No

Name

of

Creator:…………………��………………………………………………………………
………………….
Address

of

Creator:……………………………………………………………………………………
……………….

A statement justifying the applicant's right to the design is enclosed: Yes

(c)

No

The Creator does not wish to be named in the Certificate of registration of the
Industrial Design in accordance with section 29(6) of the Patents, Industrial
Designs and Trademarks Act 2002.

A declaration to that effect is enclosed
OR

will

be

filed

by……………………………………………………………………………………(date)
______________________________________________________________________________
_____________________
3.

AGENT
Name

of

agent

(if

you

have

one)

………………………………………………………………………………………………….
“Address for service" in Mauritius to which all correspondence should be
sent………………………………………………
………………………………………………………………………………………………
…………………………………………
Name

and

telephone

number

of

person

to

contact

in

Mauritius.……………………………………………………………….
………………………………………………………………………………………………
…………………………………………

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