Form TM12

Trade Marks Registry

Notice to surrender a registered mark

Your Reference :
Give details of the Registration this will affect:
Registration Number: *
Choose Lowest Class *
Total Charge : $
Full Name Of Registered Proprietor
Address Of Registered Proprietor
Postal Code Of Registered Proprietor
Email Of Registered Proprietor
Name of Agent:
Address for Service in Jamaica
Enter Details if any licensesor anyone else has registerd interest in the Registration
DECLARATION: I confrim that there are no interested parties in the Mark.(*)
Name [Block Capitals]
Date of Application:
Name of DayTime Contact :
Telephone of DayTime Contact :
Does any licensees or anyone else has a registered interest in the registration?
Declaration:
List of Registered Interested Parties (if applicable):
Charge for Service: $