P17-APPLICATION FOR COMPULSORY LICENCE TO EXPLOIT PATENT IN PUBLIC INTER.._

REPUBLIC OF NAMIBIA

BUSINESS AND INTELLECTUAL PROPERTY

AUTHORITY (BIPA)

INDUSTRIAL PROPERTY ACT, 2012 Form No. P17

APPLICATION FOR COMPULSORY LICENCE TO EXPLOIT PATENT IN PUBLIC INTEREST

(Section 57(3) and regulation 57(1)(a))

In the Matter of:

Patent/Utility Model No. Date of Grant

Applicant

Name Address

Address for Service Nationality

Country of Residence/Place of Business

Telephone No. E-mail Address

Title of the invention

Owner of the invention

Request

The above applicant hereby requests the BIPA Board, in respect of the patent/utility model, identified

above, to grant a non-voluntary licence under Section 57 of the Industrial Property Act 2012, in

accordance with the terms proposed and upon the grounds set out below.

Proposed Terms

Amount and conditions of payment of remuneration:

Conditions of exploitation of invention:

Others:

Facts Justifying Grant of Licence

Additional Information

The following items accompany this Form:

Evidence that the owner of the patent or utility model has received a request from the applicant

to obtain a licence but that the applicant has been unable to obtain such a licence on reasonable

terms and within a reasonable time.

Plan according to which the applicant intends to work the invention, including evidence that

applicant has the ability to do so in Namibia.

Other (Specify)

Signed this _________________________ day of _______________________________ 20 _____

____________________________

Signature (Applicant/Agent)