(To be deleted if the person appointing the agent desires his own
address to be treated as the address for service after registration.)
I/We also authorise the said (2)
to complete the entry of an address for service as part of any registration obtained under the
above authorisation.
Dated this
day of ............................................., 19 ...........
(4)
Address:
(5)
The Registrar,
The Designs Office,
Lusaka,
Zambia.
person
appointing
the agent
(5) Here
insert full
trade or
business
address of
the person
appointing
the agent