FORM 29



DESIGNS ACT, 1911 Request for Certificate section 59 and rule 63

FEERs.25

In the matter of Design No. 1.................................Class................................I/we2

.................................hereby request you to furnish me/us...............with your certificate to

the effect that3..............................................................................and to send the certificate to..................................................... The purpose for which the certificate is required is as follows:

..................................Dated this....................................day of.………………....19.............. (Signed)...... .......... ...............

To

The Controller of Patents and Designs,

The Patent Office, Calcutta.

1. Insert number and class of design.

2. Insert name, address and nationality.

3. Set out the particulars which the Controller is requested to certify.