reg. 34.
Form 5.

Notice of Surrender of a Patent.

The Patents Act.
I/We _______________________________________________________1
give notice that I/we have surrendered all the following claims 2___________
____________________________________________________________
____________________________________________________________
in respect of Patent No. __________.

Dated this ______ day of _______________, 20 ____

3

__________________________________________________________

My/Our address for service in Uganda is _____________________________
____________________________________________________________
_____________________________________________________________

1

State in full, name and address.

Insert the surrendered claims if not all are surrendered.

3
To be signed by the patentee(s) or his/her/their agent.

2

Select target paragraph3