IPINIlINGA/T/2
Page 64
FORM
17
TRADE MARKS ACT
(FEE STAMP-ITEM 9 or 9a)
Request to the Registrar to register a subsequent Proprietor oj a
Trade Mark or Trade Marks upon the same devolution oj title
(Regulation 74)
I, (or We)
.
hereby request that my (or our) name
entered in the Register of Trade Marks as Proprietor
of Trade Mark(s) No
"In Class
as from the (h)
I am (or we are) entitled to the Trade Mark(s) by virtue of (c)
may be
.
..
..
.
The trade mark at the time of assignment was (d) (not) used in a business
in the goods in question, and the assignment (d) (took) (did not take) place
on or after the commencement of the Act otherwise than in connection
with the goodwi11 of a business in the goods (d) and there is sent herewith
a copy of the Registrar's directions to advertise the assignment, a copy of
each of the advertisements complying therewith, and a statement of the
dates of issue of any publications containing them.
DATED this
day of '"
19
(e)
.
.
To:
The Registrar of Trade Marks,
Federal Ministry of Trade and Tourism,
Abuja, Nigeria.
Note.-The instrument under which the Transferee claims should
preferably accompany this Form.
A request for the entry of an address for service of the subsequent
proprietor may be made on an unstamped copy of Form 33, if it
accompanies this Form.
(a) Here insert full name, trade or business address, nationality and
description.
(h) Insert date of acquisition of proprietorship.
(c) Here insert full particulars of the instrument of assignment or
transmission. if any, or statement of case.
(d) Strike out any words not applicable (see regulation 78).
(e) Signature.
*Additional numbers may be given in a signed Schedule on the back of
the Form.