328
Form No.5 (cont'd)
Telephone No.:
111. CREATOR
The creator is the applicant
D
Additional information is contained
in supplemental box
D
If the creator is not applicant:
Name:
Address:
The statement justifying the applicant's right accompanies
this Form
D
IV. REPRESENTATIONS OF THE INDUSTRIAL DESIGN, SPECIMEN
This Form is accompanied by:
D four graphic representations
D four drawings or tracings
D a specimen of the industrial design
V. PRODUCTS
The kind of products for which the industrial design is to be used is (are) the
following:
VI. PRIORITY CLAIM (if any)
The priority of an earlier application is claimed as follows:
Country:
Filing Date:
Application No.:
The priority of more than one earlier application is claimed; the data
are indicated in the supplemental box
D
The certified copy of the earlier application
accompanies this Form
D
D
will be furnished within three months of the filing of this Form
VII. FEES accompany this Form
D
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