P19-APPLICATION FOR ENDORSEMENT OF LICENCE OF RIGHT

REPUBLIC OF NAMIBIA

BUSINESS AND INTELLECTUAL PROPERTY

AUTHORITY (BIPA)

INDUSTRIAL PROPERTY ACT, 2012 Form No. P19

APPLICATION FOR ENDORSEMENT OF LICENCE OF RIGHT

(Section 62(1) and regulation 59(1))

For Official Use

Received on:

_______________________________________________________________________________

In the Matter of:

Patent No.

Applicant(s)/Owner(s)

Name

Address

Telephone No. E-mail Address .

The owner of the patent indicated above hereby applies for the endorsement on the patent of the

words “Licences of right” pursuant to section 62(1) of the Industrial Property Act, 2012

Address for Service:

Additional Information

The following items accompany this Form:

Statement that the applicant is not precluded to grant licences under the patent

Other (specify)

Signed this _________________________ day of _______________________________ 20 _____

________________________________

Signature (Owner/Agent)