IPlNlllKENffII
Page 98
(Subsidiary)
Form TM ]6
DECLARATION (ONLY TO BE FURNISHED \VHEN REQUESTED BY THE
REGISTRAR) IN SUPPORT OF STATEMENT OF CASE ACCOMPANYING"
FORM
Ttv1 14
OR T~l·15
I,
,
of
.
do solmenly and sincerely declare as follows: .
The particulars set out in the Statement of Case, exhibit marked
................ and left by me in connex ion with my request to be
registered as subsequent proprietor of the Trade Mark No
in Class
.
, are true and comprise every material
fact and document affecting the present proprietorship of the Trade
Mark.
I make this -declaration conscientiously believing fhe same to be
true and according to the Oaths and Statutory Declarations Act.
Declared at
(a) To be signed
by the person
making the de
claration.
}
................... (a)
day of
this
, 19
.
Before me,
Signature
and
title
of
authority before
whom
declara
tion is made.
(b) ..................................•.....
(b)
To: The Registrar of Trade Marks,
P.O. Box 30031,
Nairobi.
52 of 86