Name:………………………………………………………………………………………………
…………………………….
Address……………………………………………………………………………………………
……………………………..
………………………………………………………………………………………………………
…………………………….

A copy of the reproduction of the industrial design
[…….] is affixed hereto
[……..] accompanies this Certificate

Dated

this………………………………………day

of…………………………………….20

…….

Signature………………………………..…

The Controller
Industrial Property Office
Ministry of Foreign Affairs,
International Trade & Cooperation
Port Louis
Republic of Mauritius

TWELFTH SCHEDULE
(regulation 41(1))

THE INDUSTRIAL PROPERTY OFFICE
REPUBLIC OF MAURITIUS

Select target paragraph3