P11-APPLICATION FOR RESTORATION OF PATENT UTILITY MODEL OR APPLICATION

REPUBLIC OF NAMIBIA

BUSINESS AND INTELLECTUAL PROPERTY

AUTHORITY (BIPA)

INDUSTRIAL PROPERTY ACT, 2012 Form No. P11

APPLICATION FOR RESTORATION OF PATENT/UTILITY MODEL OR APPLICATION

(Section 47(1) and regulation 52(1))

For Official Use:

Official date stamp

_______________________________________________________________________________

In the matter of Patent //Utility Model/Patent Application No. _______

I/We, ________________________________________________________________________

give notice of my/our intention to restore the above identified Patent/Utility Model/Patent Application.

The grounds for this restoration are as follows:

Applicant/Agent

Name

Address

Telephone No. E-mail Address

Supporting evidence accompanies this Form

Power of Attorney accompanies this Form.

Fees accompany this Form.

Signed this _________________________ day of _______________________________ 20 _____

____________________________

Signature (Applicant/Agent)