This form is divided into three Parts i.e. A, B & C. Part A and C are required to be filled compulsorily. Part B is further divided into several subcategories and the same is required to be chosen by the applicant as per requirement and be filled accordingly. [Note: One form is meant for one request only. Different forms should be submitted for different requests. In case more than one request is claimed in one form the first one will be entertained and rest of the requests will be ignored.] [(a) One form is meant for request of one change only. Different forms should be filled up for different changes (b) The relevant information must be filled up in colored box against the respective head.]

PART A [application details]

1

[The Applicant here means the person on whose behalf the request is being submitted. He will ordinarily be the registered proprietor of the mark or a person claiming to be subsequent proprietor of the mark by virtue of any assignment or transmission]

FEE (See First Schedule for Appropriate Fee)

Name: *

trading as:

Address: *

(State) (Country)

Address for service:*

(State) (Country)

[(a) Unless otherwise specifically stated, the applicant's address shall be the address for service of the applicant who has principal place of business in India.

(b) The address for service in India must be provided, in case the applicant does not carry business in India]

Mobile No :

E-mail address: *

2

APPLICANT'S AGENT (if any)

Name:*

Address:*

[In case of authorization of agent, the address of the agent may be mentioned as the applicant's address for service]

Mobile No:*

E-mail address:*

Nature of the Agent

[The applicant must choose either of the following categories- 1. Registered Trade Marks Agent, 2. Advocate 3. Constituted Attorney]

3

REQUEST/ APPLICATION FOR AMENDMENTS IN THE DETAILS OF REGISTRATION OF A TRADEMARK

Registered TM No(s).

[In case of request made for more than one trademarks, the first trademark number should be written.]

Additional Nos., if any:

Reason for amendment:

TYPE OF MARK

[(a) The applicant must choose either of the following categories- 1. Standard trademark, 2. Collective Mark, 3. Certification Mark, 4. Series Marks

Standard mark here means an application for registration of a normal trademark not being Collective or Certification trademarks or Series of marks]

PART B: PURPOSE OF REQUEST [application column required to be ticked as filled in]

a

Request for Amendment In Proprietor / Registered users detail [single request can be made under one application]

Amendment Requested In

Proprietor Name / Registered user name :

[This block should be used only when there is no change in the proprietorship of the mark by virtue of assignment or transmission]

Address:

Address For Service:

Agent/Attorney Details:

[Any of the above may be chosen and the change requested should be clearly mentioned against relevant column.]

b

Amendment In the Trademark

Enter or paste proposed trade mark here

Striking Out Goods or Services from the Register

[Change requested should be clearly mentioned here.]

Conversion of Specification of Goods and Services

[change requested should be clearly mentioned here]

c

Cancellation of the Registration

[Cancellation of the registration requested should be clearly mentioned here.]

d

Dissolution of the association between a registered trademarks and other trademarks

Registered trademark No(s)

[Enter the trade marks numbers whose association with the referred registered trademark is requested to be dissolved]

e

Assignment or Transmission of Registered trademark(s)

Assignment

Applicant must mentioned as assignment is with goodwill or without goodwill

Date of assignment deed or the date of transmission

f

Assignment to different people for different parts of India

Name of proposed assignee

Address of proposed assignee

[(a) Add details of assignees if there are more than one assignees, against relevant row. ]

[(b) Please mention the region specifically with the proposed assignee ]

g

Certificate of the Registrar under section 40 (2)

Request for the certificate under rule 83

[The details of the request in terms of Section 40(2) must be mentioned here and the statement of case with copy of the assignment must be submitted.]

h

Approval of the Registrar under section 41

Request for the approval

[The details of the request in terms of Section 41 must be mentioned here and the statement of case with copy of the assignment or transmission must be submitted.]

i

Application under Section 42 for direction of the Registrar for advertisement of assignment without goodwill of a trademark

Request for the direction

[The details of the request in terms of Section 42 must be mentioned here and the statement of case with copy of the assignment or transmission must be submitted.]

j

Application for the consent of the registrar to the assignment or transmission of certification trademark

Draft deed of proposed assignment and statement of case be along with affidavit submitted

k

Application for extension of time under Section 42 for direction of the Registrar for advertisement of assignment without goodwill of a trademark

Application for extension of time

[The details in terms of Section 42 must be mentioned here.]

Application submitted within the period from the date of acquisition or devolution

Not exceeding one month Not exceeding two month Not exceeding three month

l

Application for extension of time under Section 46(4) for registering a company as subsequent proprietor of a trademark

Application for extension of time

[The details in terms of Section 46(4) must be mentioned here.]

Application submitted within the period

Not exceeding two months Not exceeding four months Not exceeding six month

[Any one of the above should be selected]

PART C

[details of the person making application/request and details of document is submitted]

a

Signature

Name

Authority

b

List of documents attached