P10-PAYMENT OF ANNUAL FEES

REPUBLIC OF NAMIBIA

BUSINESS AND INTELLECTUAL PROPERTY

AUTHORITY (BIPA)

INDUSTRIAL PROPERTY ACT, 2012 Form No. P10

PAYMENT OF ANNUAL FEES

(Section 46(1) and regulation 51(1))

Patent/Utility Model/Application No. Renewal Date Applicant’s or Agent’s Reference

Full Name of Patentee/Utility Model Owner/Applicant

Address for Service

I forward herewith the following amounts.

The amount of N$ __________ in respect of a renewal fee is hereby paid to keep the above

patent/utility model/application in force for another period of ______ year(s) with effect from

the above-mentioned renewal date.

The amount of N$ __________ is hereby paid and you are requested to grant an extension of

_______ month(s) for the payment of the renewal fee.

The amount of N$ __________ in respect of outstanding annual fees after restoration of patent/

utility model.

Signed this _________________________ day of _______________________________ 20 _____

____________________________

Signature (Applicant/Agent)

_______________________________________________________________________________

For Official Use:

Receipt of the above amount(s) is hereby acknowledged and Receipt No.

by virtue of such payment the rights of the patentee(s) remain

in force.

The request for extension of time is hereby granted/refused

Official Date Stamp