Form TM21

Trade Marks Registry

Application to Remove or Amend a Licence

Your Reference :
File Number: *
Total Charge : $
Full Name of Current Registered Proprietor:
Full Name of Registered Proprietor:
Full Name of Agent in Jamaica:
Full Address of Agent:
Give Details on the Removal or Amendment:
Signature of Applicant :
Name [Block Capitals]
Date of Application:
Signature of New Proprietor/Grantor:
Name [Block Capitals]
Name of DayTime Contact :
Telephone of DayTime Contact :
State the Number of Sheets Uploaded for this notice:
Charge for Service: $