337
Form No. 10 (cont'd)
Nationality:
Country of residence or principal place of business:
Telephone No:
Telegraphic Address:
Telex No.:
* Delete whichever does not apply.
Indicate application or title concerned.
~*
V. ADDITIONAL INFORMATION
The following items accompany this Form:
D
D
the original or a certified copy of the document evidencing the change
of ownership, signed by or on behalf of the contracting parties
other documents evidencing the change in ownership (specify)
Dfees
D
D
other (specify)
approval of the Minister*
VI. SIGNATURES** ....................................... .
(New Applicant(s)/New Owner(s) )
(Date)
........................
(Applicant(s)/Owner(s) )
(Date)
* Required where the request is in respect of a collective mark.
** Type name(s) under signature(s) and delete whichever does not apply.
(Form No. 10 second and last page)
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