TM 1- Application for Registration of a Mark

REPUBLIC OF NAMIBIA

BUSINESS AND INTELLECTUAL PROPERTY AUTHORITY (BIPA)

INDUSTRIAL PROPERTY ACT, 2012

Form No. TM 1

REPUBLIC OF NAMIBIA

BUSINESS AND INTELLECTUAL PROPERTY AUTHORITY (BIPA)

INDUSTRIAL PROPERTY ACT, 2012

Form No. TM 1

APPLICATION FOR REGISTRATION OF MARK

(Section 140(1) and regulations 96(1), 98(1),99 and 101(2))

For Official Use:

Received on.:

Filing Date: (Official Date Stamp)

The Applicant(s) request(s) the registration of a mark in respect of the following particulars: (in case of two or more applicants, provide details on a separate sheet)

Name

Address (Street Address): Postal Address

Telephone No. E-mail Address

Agent

The following Agent has been appointed by the applicant(s) in the Power of Attorney Form accompanying this Form

to be filed within one month from filing of this Form

Name

Address

Telephone No. E-mail Address

Certification / Collective Mark

The rules / regulations governing the use of the collective mark are attached this application for registration concerns a collective mark

Reproduction of Mark

Attachment Checklist

Three additional reproductions on a separate sheet are affixed

Transliteration accompanies application

Translation accompanies application

Fees

Fees accompany application

Specification of Goods/Services and Classes

Registration is requested in respect of the following goods and/or services, listed under the applicable classes of the International Classification- Indicate Class followed by description:

Priority Declaration

Specify information on Priority Claim

Country (if the earlier application is a regional or international application, indicate the office with which and the countries for which it was filed):

Additional Information (Endorsements)

Specify any additional information accompanying this Form:

Signed this_______day of____________________20____

Signature (Applicant/Agent)