IPIN/lINGA/T/2
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18
TRADE MARKS ACT
Declaration (only to be furnished when requested by the Registrar)
in support of Statement oj Case accompanying Form 16 or 17
(Regulation 76)
FORM
I,
.
of
.
do solemnly and sincerely declare that the particulars set out in the state, and left by me in connection
ment of case, exhibit marked
with my request to be registered as subsequent proprietor of the trade
Mark No
in Class
, are
true and comprise every material fact and document affecting the present
proprietorship of tlie Trade Mark.
And I make this solemn declaration conscientiously believing the same
to be true, and by virtue of the provisions of the Oaths Act (Cap. 333).
(a)
Declared at
this
.
in
day of
19
.
.
Before me
To:
The Registrar of Trade Marks,
Federal Ministry of Trade and Tourism,
Abuja, Nigeria.
(b)
.
(a) To be signed here by the person making the declaration.
(b) Signatures and title of Authority before whom the declaration is
made.