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Form D16
Request for search and inspection
(Sections 8, 9, 22 - Regulation 49)
(Lodge in duplicate)
Name of person lodging request:
Name of person to be debited:

I hereby request:
1.
that I be permitted to search in classes) _______________________________ in
respect of a design relating to ____________________________________;
2.
that I be permitted such inspection of records as I may be entitled to; and
3.
that I be permitted to make or be supplied with the following copies ______________.
Date:
_____________________________
SIGNATURE
Address for service:

FOR OFFICIAL USE ONLY
1.
2.
3.

The above request is allowed/refused
Amount to be paid _________________
Copies supplied __________________

Official date stamp

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