319
SECOND SCHEDULE (Reg. 3 (I) )
FORMS
REGISTRAR'S OFFICE, LESOTHO
Form No. I (Reg.9(l) )
INDUSTRIAL PROPERTY ORDER
For Official Use
REQUEST FOR GRANT OF PATENT
OR UTILITY MODEL CERTIFICATE
Date of Receipt by Registrar's Office:
To: The Registrar
Registrar's Office
P.O. Box 33
Maseru 100
Application No:
(Office's Stamp)
FILING DATE:
Applicant's or agent's file reference:
D
PATENT
THE APPLICANT(S) REQUEST(S) THE GRANT OF A
UTILITY MODEL CERTIFICATE IN RESPECT OF THE FOLLOWING
PARTICULARS:
D
I.
II.
TITLE OF INVENTION:
APPLICANT(S) (The data concerning each applicant must appear in this
box or, if the space is insufficient, in the supplemental box.)
Additional information is contained in supplemental box
Name:
Address:
Nationality:
Country of residence or principal place of business:
Telephone No:
III.
Telegraphic Address:
Telex No:
AGENT
The following agent has been appointed by the applicant(s) in the power
of attorney
accompanying this Form
to be filed within one month
from the filing of this Form
Name:
D
D
Address:
Telephone No:
IV.
INVENTOR.
The invetor is the applicant
Additional information is contained