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Form D15
Request for certificate or copy
(Sections 9, 40 - Regulation 48)
(Lodge in duplicate)
Date of lodgement:
Design application/registration No

Full name(s) of applicant(s):

In terms of the following sections and/or regulations:
(a)
(b)

section
regulation

the applicant hereby requests the following:
1.

………… copy/copies of the following document(s):

2.

Certificates) for use in:

Documents, if any, lodged in support of the request:
Date:
_____________________________
APPLICANT/APPLICANT'S AGENT
Address for service:

FOR OFFICIAL USE ONLY
The above

copy/copies
certificate(s)

are attached.

Official date stamp

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