Form 12

The Patents and Design Act, 2020

First Schedule (Section 85(1))

Application to registration a design

1. Your reference :

2. Please list the classes and sub-classes if applicable in respect of which you seek registration:

Select the Classes
Select The Sub-Clasess
No Items Added as Yet !

3. Full name and address of the applicant or of each applicant. (underline all surname):

Applicant's Full Name:
Address of Applicant

No Applicant Added as Yet !

Your Application details, including your name and address, will appear on our records in the office, which are searchable by the public.

If you are applying in the name of company, where is it incorporated?

4. Name of your agent (if you have one):

Agent's Name
Address of Agent/Address for service:
Email Address to which all corresponence shall be sent:

5. Fees enclosed:

6. Name, e-mail address, telephone, fax and /or mobile number, if any, of a contact point for the applicant:

Contact Name:
Contact Fax Number:
Contact Email Address:
Contact Telephone:
Mobile Telephone:

7. Name of the Applicant

8. Which product or products is the design for? (*)

Enter Products

9. How many illustration sheets are there for this design?
Illustration Sheets:

10. Write "RSP" (Repeat Surface on Product) if this is the design of a pattern which repeats across the surface of the product, for example, wallpaper:

is this a RSP Product?

11. Please give a brief description of the design shown in the illustation or sample:"

Description

12. List Any Limitations or disclaimers you want to record:

Limitations or disclaimers

13. Publication

Should this design be published or deferred?

14. Priority Information

Have you included priority documents with this application?

15. If you ae claiming priority from an earlier application to register this design, give these details:

Application Number:
Date of Filing (dd/MM/yyy)
Country

16. If an earlier applicaiton was made in a different name, please state how the current applicaant has a right to apply. If, for example, by assignment of the earlier application, give the date of that transaction:

Please state how the current application has a right to apply:
Date of that transaction:
Charge for Service: $
Date of Application