SIGNED DECLARATION OF PROOF OF USE (Unregistered/Common Law Marks) INSTRUCTIONS 1. Complete all the required fields. 2.Signed document must be uploaded to your account by accessing: www.markvalidation.co.za. General queries may be directed to [[email protected]] 3. Have the form commissioned before a Commissioner of Oaths or the Foreign equivalent. Any annexes must also be initialled. PLEASE COMPLETE MANDATORY FIELDS WORD OR WORD STRING LOADED ONTO YOUR MVS ACCOUNT FULL NAME OF ACCOUNT OR MARK HOLDER REGISTERED ON MVS DULY AUTHORISED REPRESENTATIVE REGISTERED ON MVS (Full Names) REPRESENTATIVE’S CAPACITY (Please circle the appropriate capacity) Member/Director/CEO/Senior Manager/Owner/President/Chairman/Partner/ Sole Proprietor/Company Secretary/Trustee/Agent/ Liquidator/Executor/Guardian/Curator UNDERTAKING: I the undersigned do hereby make oath and say: 1.
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The information provided in this Form is to the best of my knowledge and belief both true and complete. I am duly authorized to depose to this affidavit in the capacity indicated above. I confirm that the information (annexure/annexes) submitted through the mark validation system constitute sufficient proof that the word or word string is currently being used and has been used in the ordinary and legitimate course of my business activities to such an extent that it has been or is currently being associated with or connected to the goods and/or services that I provide. rd
I have no knowledge that any 3 party has applied for an assessment of the same or similar word or word string through the mark validation system and undertake to immediately notify the mark validation administrator of any changes to the information submitted and, to provide the necessary additional information to maintain the accuracy of information that has been supplied. I further confirm that, to the best of my knowledge, there is no legal or other impediment that prevents me from participating in this pre-­‐validation process. I fully understand and accept that any assessment undertaken within the framework of the mark validation system does not in any way or under any circumstances confer any exclusive and inviolable common law or registered trademark rights capable of being enforced in any national jurisdiction. I acknowledge that ZA Central Registry reserves all their rights in accordance with the Terms and Conditions of the ZA Central Registry and set ZA Central Registry Policies, and I specifically undertake to indemnify them against any liability or damages (of whatsoever nature) incurred as a result of my participation in the mark validation process. SIGANTURE: _________________________________ ON BEHALF OF THE APPLICANT DATE: ___________________________ PLACE: __________________________ COMMISSIONER OF OATHS:
The above named person has acknowledged that he/she knows and
understands the contents of this document, has no objection to taking the oath
and has sworn that the contents thereof are true and correct, and that he/she
considers the oath to be binding on his/her conscience.
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COMMISSIONER OF OATHS
NAME:
DESIGNATION:
DATE:
PLACE