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Form D13
Application for the voluntary surrender of a registered design
(Section 34 - Regulation 42)
(Lodge in duplicate)

Design No.:

Date of lodgement.:

Full name(s) of registered proprietor(s):

Class:
Type of design

Part A

Part F

I/We .......................................................................................................................................
.......................................................................................................................................
hereby declare that1. (a) I/we am/are the proprietor(s) mentioned above;
1. (b) I/we am/are authorised by the proprietor(s) to make this offer;
2.
I/we hereby offer to surrender the above-mentioned design registration;
3.
no action for infringement or proceedings for revocation of the design are pending
except as set out below; and
................................................................................................................
................................................................................................................
4.
the reasons for making this offer are as follows:
................................................................................................................
................................................................................................................
Date:
________________________________
APPLICANT/APPLICANT'S AGENT
Address for service:

FOR OFFICIAL USE ONLY
The above offer to surrender has been allowed/refused

Official date stamp
……………………
…..

Select target paragraph3