TRADE MARKS FORM NO22 STOCKED BY THE TRADE MARKS

(1) Here state present name, address and description of registered proprietor or registered user

(2) Strike out the words that are not applicable

*Additional numbers may be given on a signed schedule on the back of the form

(3)Here state the circumstances under which the change of name took place

(4) Signature

I/We(1) .....................................................................................................................................................

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hereby request that my/our name(s) may be entered in the register of trade marks as (2) proprietor(s)/registered

in user(s) of the trade mark(s) No(s) ..............................................................* registered in Class(es) ....................

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Iam/we are entitled to (2) the said trade mark(s)/use the said trade mark(s) as the registered user(s).

There has been no change in the (2) actual proprietorship/identity of the registered user(s) of the said

trade mark(s), but (3) ...............................................................................................................................

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The entry at present standing in the register gives my/our name(s) and description(s) as follows:-

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Dated this ...............................................day of ............................................................., 20....................

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THE REGISTRAR

THE TRADE MARKS OFFICE

P. O. BOX 32075

LUSAKA

ZAMBIA