FORM TM- 17

TRADE AND MERCHANDISE MARKS ACT, 1958

Application for the certificate of the Registrar under See. 39 (2) with reference to
a proposed assignment of a registered trade- mark
Rule 80

(To be accompanied by a statement of case in duplicate and a copy of the proposed assignment)
IN THE MATTER OF Trade Mark (s) No(s)…………….registered in the name of ……………….. in class(es) …………………….
Application is hereby made by1………….being the registered proprietors of the abovementioned registered trade mark(s) for the Registrar’s certificate under See. 39 (2) with reference to a proposed assignment of the registered trade mark(s) No(s)…………….. to2……….. in circumstances that are stated fully in the accompanying statement of case.
Dated this ……………….day of……….. 19………
3.....................
To
The Registrar of Trade Marks,
The Office of the Trade Marks Registry at4
1. Insert the name and address of the registered proprietor.
2. Insert the name, address and nationality of the proposed assignee.
3. Signature of the registered proprietor of his agent.
4. State the name of the place of the appropriate office of the Trade Marks Registry-See rule 4.