Form P18

REPUBLIC OF SOUTH AFRICA

PATENTS ACT, 1978

REQUEST FOR REMOVAL FROM THE REGISTER OF PATENT AGENTS AND PATENTS'

ATTORNEYS

(Section 23 - Regulation 72)

I, the above mentioned applicant, hereby request in terms of section 23 (1) (a) that my name be removed from the above register, and

I hereby declare that no disciplinary enquiry or proceedings are pending against me by the South African Institute of Intellectual Property Law or any law society and that the reasons why I seek to have my name removed from the register are .....................................................................................................................................

Declared at ............................. this....................... day of...................... 19 ............

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Signature

Received copy hereof this ...................................... day of ....................................... 19 ............

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S.A. Institute of Intellectual Property Law        

Received copy hereof this .......................................... day of ................................... 19 ...........

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Law Society