Application is hereby masge for registration of the geographical indication (details of
which accompany this Form) in the name of the Applicant(s) acting in the capacity of:
The particulars required for the purposes of the application are set out below:
PARTICULARS
I. APPLICANTS
Nationality
II. DULY AUTHORIZED AGENT:
The following has been appointed by the applicant as his duly authorized agent
III. GEOGRAPHICAL INDICATION
The geographical indication for which registration is sought is the following:
IV. GEOGRAPHICAL AREA
The following is the demarcation of the territory of the country, region or locality in that territory to which the geographical indication application applies, and from which the goods for which the geographical
indication is used originate:
V. Goods
The goods for which the geographical indication is used are the following:
VI. QUALITY, REPUTATION OR OTHER CHARACTERISTICS
The quality, reputation or other characteristics of the goods for which the geographical indication is used, and any conditions under which then indication may be used, are the following: