CM 5 Application for Reservation of Name or Shortened Form or Defensive Name

The form is always available to download and submit on paper.

Form CM 5

REPUBLIC OF NAMIBIA

BUSINESS AND INTELLECTUAL PROPERTY AUTHORITY - BIPA

COMPANIES ACT 2004

(Sections 48(1) and 49)) (Regulation 14(1))

(To be lodged in duplicate)

APPLICATION FOR RESERVATION OF NAME OR SHORTENED FORM OR DEFENSIVE NAME

Business and Intellectual

Property Authority - Business Registration office

PO Box 185

WINDHOEK

NAMIBIA

Tel: +264 61 2994400

Email: info@bipa.na

N$ 75,00 fee payable in terms of the Act and as set out in the regulations

A. Proposed Name

or Shortened Form

or Defensive Name

(indicate with a cross (“X”))

In order of preference

For Office use

Initials & Date

Approved / not approved

approved / not approved

Reservation is valid for two months

B. Comparative Names (For Office Use)

C. Is the proposed name associated with a person or a company? If so, what is the name and number

(if a company) and the nature of the association (e.g. holding/subsidiary/director etc)?

D. Purpose of proposed company

E. In case of a DEFENSIVE NAME, submit written proof that applicant has a direct and material interest in the name

F. If name of company or shortened form thereof is in a language other than the official language, provide translation thereof in as far as possible.

Translation:

Name of Applicant (print)

Address to which form must be returned

Signature of applicant/agent

Postal Address:

E-mail Address:

Date

Mobile Number:

Telephone Number: