Form TM12

Trade Marks Registry

Notice to Surrender a Registered Mark

Your Reference :
Give details of the Registration this will affect:
Registration Number: *
List of Selected File Numbers
Total Charge : $
Choose Lowest Class *
Full Name Of Registered Proprietor
Address Of Registered Proprietor
Postal Code Of Registered Proprietor
Name of Agent:
Address for Service in Jamaica
Enter Details if any licensesor anyone else has registerd interest in the Registration
Signature of Applicant:
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 :
State the Number of Sheets Uploaded for this notice:
Charge for Service: $