1978

THE NEW ZEALAND GAZETTE.

[No. 53

of Trade-marks as proprietor[s] of the Trade-mark No. in Class .
I am [or We are] entitled to the said trade-mark and to the goodwill of the business concerned in the goods with respect to which the said trade-mark is registered.
Accompanying this request is a statement of my [or our] case.

Dated this day of , 19 . [Signature.]
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 17.
The Patents, Designs, and Trade-marks Act, 1911.
FORM OF DECLARATION (TO BE FURNISHED ONLY WHEN REQUESTED BY REGISTRAR) IN SUPPORT OF STATEMENT OF CASE ACCOMPANYING

I, , of , do hereby solemnly and sincerely declare that the particulars set out in the statement of case, exhibit marked , and left by me in connection with my request to be registered as subsequent proprietor of the Trade-mark No. in Class , are true, and comprise every material fact and document affecting the proprietorship of the said trade-mark as above claimed.
And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the Justices of the Peace Act, 1908.

Declared at , this day of , 19 , before me,— [Signature and title of the authority before whom the declaration is made.]
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 18.
Stamp, 5s.* (Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
NOTICE OF APPLICATION FOR ALTERATION OF ADDRESS ON REGISTER OF TRADE-MARKS.

In the matter of the Trade-mark No. registered in Class .
I, , of , the registered proprietor of the trade-mark numbered as above, desire that my address on the Register of Trade-marks be altered to .
Dated this day of , 19 . [Signature.]
To the Registrar, Patent Office, Wellington, New Zealand.

• If address altered in more than one case at same time attach 5s. stamp for first and 1s. stamp for each of other marks.

[Form No. 19.
Stamp, 5s. (Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
APPLICATION TO PERMIT AN APPORTIONMENT OF TRADE-MARKS.

In the matter of the registered Trade-marks Nos. .
We, being the parties interested within the meaning of section 78 of the Patents, Designs, and Trade-marks Act, 1911, in certain marks of , who has ceased to carry on business, request you to permit an apportionment of those marks amongst the persons in fact continuing the business. With this application we send a case in pursuance of Regulation No. 74 of the regulations under the said Act relating to trade-marks.

Dated this day of , 19 . [Signatures.]
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 20.
Stamp, 5s. (Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
FORM OF REQUEST FOR CORRECTION OF CLERICAL ERROR OR FOR PERMISSION TO AMEND APPLICATION UNDER SECTION 67 (6) OR SECTION 108 (c).

Sir,—
I hereby request that . [Signature.]
Dated this day of , 19 .
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 21.
Stamp, 5s.* (Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
REQUEST TO ENTER CHANGE OF NAME OF REGISTERED PROPRIETOR OF TRADE-MARK UPON THE REGISTER.

I [or WE] [Here insert name, address, and description] hereby request that you will enter my [or our] name[s] in the Register of Trade-marks as proprietor[s] of the Trade-mark No. in Class .
I am [or We are] entitled to the said trade-mark and to the goodwill of the business concerned in the goods with respect to which the said trade-mark is registered.
There has been no change in the actual proprietorship of the said trade-mark, but [Here state the circumstances under which the change of name took place].

Dated this day of , 19 . [Signature.]
To the Registrar, Patent Office, Wellington, New Zealand.

• If more than one mark, attach 5s. for first mark and 1s. for every other mark.

[Form No. 22.
Stamp, 5s. (Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
FORM OF APPLICATION BY PROPRIETOR OF REGISTERED TRADE-MARK TO CANCEL ENTRY ON REGISTER.

Trade-mark No. , Class , advertised in page .
Name of registered proprietor: .
Place of business: .
Description: .
I, THE undersigned , of [or I, the undersigned, , a member of the firm of , of , on behalf of my said firm] apply that the entry upon the Register of Trade-marks of the Trade-mark No. in Class may be cancelled.

Dated this day of , 19 . [Signature.]
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 23.
Stamp, 5s. (Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
REQUEST TO STRIKE OUT GOODS FROM THOSE FOR WHICH A TRADE-MARK IS REGISTERED.

I, , of , hereby request that you will strike out from the goods for which the Trade-mark No. is registered in Class .

Dated this day of , 19 . [Signature.]
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 24.
Stamp, 5s. (Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
REQUEST TO ENTER DISCLAIMER OR MEMORANDUM RELATING TO A TRADE-MARK.

I, , of , hereby request that you will enter in the register in connection with Trade-mark No. in Class the following , namely,— .

Dated this day of , 19 . [Signature.]
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 25.
Stamp, 21.* (Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
APPLICATION UNDER SECTION 88 TO ADD TO OR ALTER A TRADE-MARK.

In the matter of the Trade-mark No. in Class .
Application is hereby made on behalf of the registered proprietor of the trade-mark numbered as above to alter it in