G.P-S. 019-0035
FORM TM1
Document should be typewritten in triplicate.
REPUBLIC OF SOUTH AFRICA
TRADE MARKS ACT, 1993
Client
Reference
OFFICIAL DATE STAMP
APPLICATION FOR THE REGISTRATION OF A TRADE MARK
Sections 9,14,16, 425 43 and 63 - Regulations 11, 56 and 57
One copy will be returned to the applicant's
address for service as proof of lodgement and is only
valid if endorsed with the official date stamp.
For office use only
21
Application Number
22
Filing Date
Applicant's or agent's
GPA number
NA
73
Nature (O=Ordinary, CE=Certification, CO=Collective, CU=Honest Concurrent User)
Owner/company
74
Address for service (postal address)
51
International Classification
Forename(s)
Street address
57
Specification of goods/services
58
Endorsement(s)
31
Number
32
Date
33
Country
Convention priority
claimed
54
Representation of trade mark
AS
Association No. (if applicable)
(2)
If trade mark is a word, letter, numeral or combination, insert in inner block (1)
If trade mark is represented in a special or particular form, place a good copy
in outer block (2) (Maximum size: 8,5 cm x 1 0 cm)
(1)
The applicant claims to be the proprietor of the accompanying trade mark
which is proposed to be/is being used in respect of the above-mentioned
goods or services.
Signature of applicant or authorised agent
Date