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Form D12
Application to correct and/or amend a design application or registration
(Sections 26, 27 - Regulation 41)
(Lodge in duplicate)
PART I
Date of lodgement:
Design application/registration No
Full name(s)
proprietor:
of
applicant(s)
registered
Articles to which design is to be applied:
PART II
The applicant hereby requests the correction or amendment of the above design
application/registration in terms of section 26, as shown on the attached relevant
copies.
The applicant hereby applies to amend the above design application/registration in
terms of section 27, as shown on the attached relevant copies.
The reasons for making the correction/amendment are as follows:
Date:
______________________________
APPLICANT/APPLICANT'S AGENT
Address for service:
The above request is hereby allowed/refused.
Yes
The application is to be published in the journal
No
Part I
To be published
Part II
Official date
stamps
…………………….