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Form D3
Declaration and power of attorney
(Section 14 - Regulation 12)
Date of lodgement:
Application No.:
Date of registration:
Date of publication:
Classification:
Full names) of applicant(s):
Address(es) of applicant(s):
PRIORITY CLAIMED
COUNTRY
NUMBER
DATE
Articles to which design is to be applied:
Type of design
Part A
Part F
Release date (if applicable):
Classification:
I/We ........................................................................................ hereby declare as follows:
1.
I/We am/are the applicant(s) mentioned and have knowledge of the facts herein
stated.
2.
I/We have been authorised by the applicants) to make this declaration and have
knowledge of the facts herein stated in the capacity of ................................... of the
applicant(s).
3.
The applicants) claims/claim to be the proprietor(s) of the design.
4.
The design was first made available to the public on the release date stated above.
5.
To the best of my/our knowledge and belief, if a design registration is granted on the
application there will be no lawful ground for the revocation of the design registration.
6.
This is a convention application and the earliest application from which priority is
claimed as set out above is the first application in a convention country in respect of
the design.
7.
The partners and qualified staff of the firm of .:......................., patent
attorneys/attorneys, are authorised, jointly and severally, with powers of substitution
and revocation, to represent the applicants) in this application and to be the address
for service of the applicants) while the application is pending and after a. design has
been registered.
Date: ___________________________________________
Place: ___________________________________________
_____________________
SIGNATURE(S)