Form TM20

Trade Marks Registry

Application for the Registration of a Licensee for a Registered Trademark

Your Reference :
Give Details of the Registrations you want a licensee Recorded against :
File Number: *
List of Selected File Numbers
Total Charge : $
Full Name Of Registered Proprietor:
Address:
Postal Code
Full Name Of Licensee
Address
Postal Code:
Trade Mark ADP Number:
Licence Start Date:
Licence End Date:
Is the licence to be exclusive ?
Full Name Of Agent:
Address of Agent:
Signature of Registered Proprietor:
Signature of New Licensee:
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: $