Form TM21

Trade Marks Registry

Application to Remove or Amend a Licence

Your Reference :
File Number: *
List of Selected File Numbers
Total Charge : $
Full Name of the Current Registered Proprietor :
Full Name of Registered Proprietor of thre registration:
Full Name of Agent in Jamaica:
Full Address of Agent:
Give Details on the Removal or Amendment:
Name [Block Capitals]
Signature of Applicant (or his or her representative):
Email Address: (*)
Date of Application:
Name [Block Capitals]
If you want to alter the terms of the licence and you are NOT the proprietor or grantor, the propritor must provide authorization:
Name of DayTime Contact :
Telephone of DayTime Contact :
State the Number of Sheets Uploaded for this notice:
Charge for Service: $