clxi

Here insert the goods in respect of which the registered user is entered.
Here insert one or more of the subparagraph(s) of section 31(8) numbered (i),
(ii), (iii).

clxii

clxiii

Signature.

clxiv

Insert here the name of the registered proprietor.
Insert here the name and trade or business address of the registered user.

clxv

clxvi

Signature.

Select target paragraph3