Application No.:

Date of lodgement

Date of registration

Date of publication

Classification

Full name(s) of applicant(s):

Address(es) of applicant(s):

Type of design

Part A

Part F

1.

I/We am/are the applicant(s) mentioned and have knowledge of the facts herein stated.

2.

I/We have been authorised by the applicants) to make this declaration and have knowledge of the facts herein stated in the capacity of ................................... of the applicant(s).

3.

The applicants) claims/claim to be the proprietor(s) of the design.

4.

The design was first made available to the public on the release date stated above.

5.

To the best of my/our knowledge and belief, if a design registration is granted on the application there will be no lawful ground for the revocation of the design registration.

6.

This is a convention application and the earliest application from which priority is claimed as set out above is the first application in a convention country in respect of the design.

7.

The partners and qualified staff of the firm of .:......................., patent attorneys/attorneys, are authorised, jointly and severally, with powers of substitution and revocation, to represent the applicants) in this application and to be the address for service of the applicants) while the application is pending and after a. design has been registered.