CommonLII [Home] [Databases] [WorldLII] [Search] [Feedback]

Malaysia Legislation

P.U.(A) 247/2001
GEOGRAPHICAL INDICATIONS REGULATIONS 2001


SECOND SCHEDULE - Form GI 1

CENTRAL GEOGRAPHICAL INDICATIONS OFFICE MALAYSIA
GEOGRAPHICAL INDICATIONS REGISTRY
GEOGRAPHICAL INDICATIONS ACT 2000

GEOGRAPHICAL INDICATIONS REGULATIONS 2001


    APPLICATION FOR REGISTRATION OF A
    GEOGRAPHICAL INDICATION

    [Subregulation 6(1)]



    TO: The Registrar of Geographical Indications Central Geographical Indications Office Kuala Lumpur, Malaysia.
    For Official Use:


    Date of receipt by
    Central Geographical Indications
    Office:
    APPLICATION NO.:
(Office's Stamp)
Fees received on:

    Amount:
Applicant's or agent's file reference

    THE APPLICANT REQUEST FOR THE REGISTRATION OF A GEOGRAPHICAL INDICATION IN RESPECT ON THE FOLLOWING PARTICULARS:
    I. Full name and address of applicant: .............................
    ..................................................................
    ..................................................................
    ..................................................................
    (if the applicant resides abroad, an address for service in Malaysia must be provided)
    Nationality:
    Country of residence or
    principal place for business:

    Capacity in which applicant
    is applying for registration:

    Tel. No.:Telegraphic Address:Telex No.:Fax No.:
    II. Full name and address of agent (if any): ..................
    ..................................................................
    ..................................................................
    ..................................................................
    (if this address for service and is not already on record, Form GI 2 must be filed with this Form)

    Agent's Registration No. (if known): ..................................................................

    Agent's own reference: ..................................................................
    Tel. No.:Telegraphic Address:Telex No.:Fax No.:
III. GEOGRAPHICAL INDICATION
    The geographical indication for which registration is sought is the following:


    IV. GEOGRAPHICAL AREA
    The following is the demarcation of the territory of the country, or region, or locality in that territory, to which the geographical indication applies, and from which the goods for which the geographical indication is used originate:


    Additional information, possibly in graphic form, maps, etc.:

    accompanies this Form

    is contained in the supplementary box
    V. GOODS
    The goods for which the geographical indication is used are the following:


    VI. QUALITY, REPUTATION OR OTHER CHARACTERISTICS
    The quality, reputation or other characteristics of the goods for which the geographical indication is used, and any conditions under which the indication may be used, are the following:

    Additional information is contained in the supplementary box.
    Additional information accompanies this Form
    VII. FEE
Accompanies this Form
    VIII. SUPPLEMENTARY BOX
    (Use this box if any of the boxes is not large enough to contain information to be furnished. Indicate the boxes continued in this box by their Roman numerals and title)



    IX. DECLARATION:
    Signature: ..................................................................

    Name of signatory (in block letters): ..................................................................

    Date: ..................................................................
    (If the applicant is a partnership, the full names of all partners must be stated)
Note: 1. A copy of the statutory declaration by the applicant must be attached.
    2. An agent signing this Form on behalf of the applicant must satisfy himself as to the truth of the declaration.