P12-NOTIFICATION OF CHANGE IN OWNERSHIP

REPUBLIC OF NAMIBIA

BUSINESS AND INTELLECTUAL PROPERTY

AUTHORITY (BIPA)

INDUSTRIAL PROPERTY ACT, 2012 Form No. P12

NOTIFICATION OF CHANGE IN OWNERSHIP

(Section 48(2) and regulation 53(1)(a))

Patent/Utility Model/Application Number Date of Filing

Applicant(s) / Owner(s)

Name Address

Request

The Registrar is hereby requested to record the change in ownership of the above- identified:

Patent

Utility Model

Application

The present applicant(s)/owner(s)* is/are identified above.

The new applicant(s)/new owner(s)* is/are identified below.

New Applicant(s) / New Owner(s)

Name Address

Address for Service in Namibia Nationality

Residence or Principal Place of Business (Country)

Telephone No. E-mail Address .

Additional Information

The following items accompany this Form:

The original or a certified copy of the document evidencing the change of ownership,

signed

by or on behalf of the contracting parties

Other documents evidencing the change in ownership Fees

Other (Specify)

Signatures

_______________________________________________________________________________

(Date) Signature (New Applicant/New Owner)

_______________________________________________________________________________

(Date) Signature (Applicant/Owner)