68
TRADE MARKS REGULATIONS, 1970 (L.I. 667)
.......................................................................................................................................
.....................................................
Trade
or
business
address
.......................................................................................................................................
...........
Description
is
hereby
made
by
.......................................................................................................................................
...
Application
is
hereby
made
by
.......................................................................................................................................
...
of(a)
..............................................................
.......................................................................................................
(or
by)
a
member
of
the
firm
.......................................................................................................................................
...................
of
(a)
.......................................................................................................................................
...........................................
on
behalf
of
my
said
firm.................................................................................................................................
...................
.......................................................................................................................................
.....................................................
for
striking
out
of
b
.......................................................................................................................................
.....................
from
the
goods
for
which
the
trade
mark
...................................................................................................................
is
registered
in
..............................................
...........................................................................................................
Dated this .......................................................day
..................................................................
(Signature) ................................................................
of
No.
Class
................................19