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Form D10
Payment and certificate of renewal (including a request for extension)
(Section 22 - Regulation 34)
(Lodge in duplicate)
Date of lodgement:
Application No.:
Renewal date:
Full names) of applicant(s):
Type of design
Part A
Part F
The undermentioned amounts) is(are) forwarded herewith:
1.
The amount of R ______in respect of a renewal fee is hereby paid to keep
the above design in force for another period of_______ years from the
above-mentioned renewal date.
2.
The amount of R ______is hereby paid and you are requested to grant an
extension of ________months for the payment of the renewal fee.
3.
The amount of R ______is hereby paid in respect of outstanding annual fees
after restoration of the design.
Date:
_______________________________
APPLICANT/APPLICANT'S AGENT
Address for service:
Receipt of the above amounts) is hereby acknowledged and by virtue of such payment the
rights of the proprietor(s) remain in force for the period shown above.
The request for extension of time is here granted/refused.
Official date stamp
…………………….
.
NOTE: Fee payable in terms of Schedule 1 to the regulations
GENERAL: The duplicate will be returned but is not valid unless endorsed with the official
stamp.