SECOND SCHEDULE - Form GI 12 (GEOGRAPHICAL INDICATIONS REGULATIONS 2001

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Malaysia Legislation

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

SECOND SCHEDULE - Form GI 12

CENTRAL GEOGRAPHICAL INDICATIONS OFFICE MALAYSIA
GEOGRAPHICAL INDICATIONS REGISTRY

GEOGRAPHICAL INDICATIONS ACT 2000

GEOGRAPHICAL INDICATIONS REGULATIONS 2001

REQUEST BY REGISTERED PROPRIETOR OF A REGISTERED GEOGRAPHICAL INDICATIONS FOR ENTRIES OF CHANGES IN THE REGISTER

[Regulations 35 and 36]

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

For Official Use:

Date of receipt by

Central Geographical Indications

Office:

Fees received on:

Amount:

Applicant's or agent's file reference

INSTRUCTION

I. REQUEST BY THE REGISTERED PROPRIETOR OF A REGISTERED GEOGRAPHICAL INDICATIONS FOR ENTERING A CHANGE IN THE DESCRIPTION, ALTERATION OF TRADE/BUSINESS ADDRESS OR CORRECTION OF AN ERROR IN THE REGISTER

II. REQUEST BY REGISTERED PROPRIETOR OF A REGISTERED GEOGRAPHICAL INDICATION FOR MAKING, CANCELLING OR VARYING OF AN ENTRY IN THE REGISTER

III. REQUEST BY REGISTERED PROPRIETOR OF A REGISTERED GEOGRAPHICAL INDICATION TO STRIKE OUT GOODS OR SERVICES

IV. APPLICATION BY REGISTERED PROPRIETOR FOR AN ADDITION TO OR ALTERATION OF A REGISTERED GEOGRAPHICAL INDICATION

(Please tick whichever is applicable)

1. Geographical Indication No.:

2. Class:

3. Full name and address of registered proprietor (PREVIOUS PARTICULARS):

..................................................................

Tel. No.:

Telegraphic Address:

Telex No.:

Fax No.:

4. Full name and address of agent (if any):

..................................................................

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

Agent's own reference: ..................................................................

Tel. No.:

Telegraphic Address:

Telex No.:

Fax No.:

I. REQUEST BY THE REGISTERED PROPRIETOR OF A REGISTERED GEOGRAPHICAL INDICATION FOR ENTERING A CHANGE IN THE DESCRIPTION, ALTERATION OF TRADE/BUSINESS ADDRESS OR CORRECTION OF AN ERROR IN THE REGISTER

I/We am/are the registered proprietor

of a registered geographical indication

I/We am/are the

entering a change in the description in the Register

alteration of trade/business address in the Register

correction of an error in the Register

(Please tick whichever is applicable)

PREVIOUS PARTICULARS:

Nmae:

..................................................................

Address:

..................................................................

LATEST PARTICULARS:

Name:

..................................................................

Address:

..................................................................

Actual date of change of:

(i) Name:

..................................................................

(ii) Address:

..................................................................

Note: A registered proprietor whose address has been altered by a public authority, while the change of address designates the same premises as before, shall attach the supporting statement together with this Form to avoid payment of fee.

II. REQUEST BY REGISTERED PROPRIETOR OF A REGISTERED GEOGRAPHICAL INDICATION FOR MAKING, CANCELLING OR VARYING OF AN ENTRY IN THE REGISTER

I/We hereby request that an entry in the Register

be made;

be cancelled; or

be varied,

in the following manner

(if the space provided is insufficient, please continue on a separate sheet which must be firmly annexed to this Form)

..................................................................

III. REQUEST BY REGISTERED PROPRIETOR OF A REGISTERED GEOGRAPHICAL INDICATION TO STRIKE OUT GOODS

The Register is requested to strike out the following goods from the registered specification:

(if the space provided is insufficient, please continue on a separate sheet which must be firmly annexed to this Form)

IV. APPLICATION BY REGISTERED PROPRIETOR FOR AN ADDITION TO OR ALTERATION OF A REGISTERED GEOGRAPHICAL INDICATION

Details of addition or alteration.

Please submit 4 copies of the geographical indication on bromide paper as it will appear when added or altered.

..................................................................

Signature:

..................................................................

Date:

..................................................................

Note: If this Form is filed by an agent, please attach Form GI 2 together with this Form.