Form TM3

Trade Marks Registry

Request to Appoint an Agent or to Enter Change of Address for Service

Your Reference :
Give details of the Applications or Registrations this will affect:
Licensee Number:
File Number: *
Full Name of Proprieor or Licensee or Opponent




(indicate(a),(b)or (c) as appropriate)
(indicate (a) or (b) and if (b) Provide details.
Select New Name or Address to be Recorded:
Signature of Applicant:
Name [Block Capitals]
Date of Application:
Charge for Service: $