REPUBLIC OF ZAMBIA
PATENTS FORM NO. 4
Sections 11, 12, 31 (2)
Regulations 3 (4)
THE PATENTS ACT
Fee unit:
APPLICATION FOR THE GRANT OF A PATENT OF ADDITION
cINSTEAD OF AN INDEPENDENT PATENT
I/We (1)
being a national/nationals of
(1) State
full name
and
address of
patentee(s)
hereby request that patent No.
of which I am/we are the patentee(s) be revoked and that instead thereof a patent of
addition to patent No. of which I am/we are also the patentee(s)
be granted to me/us, such patent of addition to bear the same date as the patent so revoked.
Dated this
day of ...........................................,19 ................
(2)
My/Our address for service in Zambia:
The Registrar,
The Patent Office,
Lusaka,
Zambia.
(2) To be
signed by
patentee(s)
or his/their
agent