JUNE 27.] THE NEW ZEALAND GAZETTE. 1683

the particular purpose for which the agent is appointed], and
request that all notices, requisitions, and communications re-
lating thereto may be sent to such agent at the above address.
I [or We] revoke all previous authorizations, if any.
I [or We] hereby declare that I am [or We are] a [Here state
nationality].
Dated this day of , 19 .
[Signature.]
[Address.]

To the Registrar, Patent Office, Wellington, New Zealand.

——
[Designs Form No. 2.
The Patents, Designs, and Trade-marks Act, 1921–22.
APPLICATION FOR REGISTRATION OF DESIGN (EXCEPT
ARTICLES IN CLASSES 13 TO 15).

You are hereby requested to register the accompanying
design in Class in the name of [Here insert in full the
name, address, and nationality of the applicant or applicants],
of , who claims to be the proprietor thereof.
The design is to be applied to .
The design has been previously registered in Classes under
No. [Strike out these words if no previous registration has
been effected].
Dated this day of , 19 .
[Signature.]

To the Registrar, Patent Office, Wellington, New Zealand.
N.B.—Four exactly similar representations or specimens
of the design should accompany this form.

——
[Designs Form No. 3.
The Patents, Designs, and Trade-marks Act, 1921–22.
APPLICATION FOR REGISTRATION OF DESIGN TO BE APPLIED
TO A SET.

You are hereby requested to register the accompanying
design for a set of articles in Class in the name of [Here
insert in full the name, address, and nationality of the appli-
cant or applicants], of , who claims to be the proprietor
thereof.
The design is to be applied to [Here set out the trade
description of each of the articles comprised in the set].
The design has been previously registered in Classes
under No. [Strike out these words if no previous registra-
tion has been effected].
Dated this day of , 19 .
[Signature.]

To the Registrar, Patent Office, Wellington, New Zealand.
N.B.—Four exactly similar representations or specimens of
the design should accompany this form.

——
[Designs Form No. 4.
The Patents, Designs, and Trade-marks Act, 1921–22.
CERTIFICATE OF REGISTRATION OF DESIGN.

Rd. No.
Patent Office, Wellington, New Zealand.
THIS is to certify that the design of which a copy is annexed
has been registered as of the day of , in
respect of the application of such design to articles comprised
in Class , in pursuance of and subject to the provisions
of the Patents, Designs, and Trade-marks Act, 1921–22, and
the regulations in force thereunder relating to designs.
…………
Registrar of Patents, Designs, and Trade-marks.

——
[Designs Form No. 5.
The Patents, Designs, and Trade-marks Act, 1921–22.
EXTENSION OF COPYRIGHT IN DESIGN FOR THE SECOND
PERIOD OF FIVE YEARS.

IN accordance with the provisions of section 56 (2) of the
Patents, Designs, and Trade-marks Act, 1921–22, the pre-
scribed fee for the extension of the copyright in the Design
No. in Class is hereby lodged.
Dated this day of , 19 .
To the Registrar, Patent Office, Wellington, New Zealand.
N.B.—This form must be endorsed with the name and
address of the person lodging the same.

——
[Designs Form No. 6.
The Patents, Designs, and Trade-marks Act, 1921–22.
EXTENSION OF COPYRIGHT IN DESIGN FOR THE THIRD PERIOD
OF FIVE YEARS.

IN accordance with the provisions of section 56 (3) of the
Patents, Designs, and Trade-marks Act, 1921–22, the pre-
scribed fee for the extension of the copyright in the Design
No. in Class for a third period of five years is hereby
lodged.
Dated this day of , 19 .
To the Registrar, Patent Office, Wellington, New Zealand.
N.B.—This form must be endorsed with the name and
address of the person lodging the same.

——
[Designs Form No. 7.
The Patents, Designs, and Trade-marks Act, 1921–22.
APPLICATION FOR ENLARGEMENT OF TIME FOR PAYMENT OF
FEE FOR EXTENSION OF COPYRIGHT IN DESIGN.

I [or We] hereby apply for months’ extension of
time within which payment of the fee of £ for the
extension of the copyright in the Design No. . in Class
may be paid.
Dated this day of , 19 .
[Signature.]
[Address.]

To the Registrar, Patent Office, Wellington, New Zealand.

——
[Designs Form No. 8.
The Patents, Designs, and Trade-marks Act, 1921–22.
REQUEST TO ENTER NAME OF SUBSEQUENT PROPRIETOR, OR
OF MORTGAGEE, OR OF LICENSEE, ETC., OF DESIGN, IN THE
REGISTER.

I [or WE] [Here insert name, address, and nationality], hereby
request that you will enter my [our] name[s] in the Register
of Designs as proprietor [or mortgagee, or licensee, or as the
case may be] of the Design No. in Class .
I am [We are] entitled to the said design.
The following documents are submitted herewith [Set out
list of documents submitted].
Dated this day of , 19 .
[Signature.]

To the Registrar, Patent Office, Wellington, New Zealand

——
[Designs Form No. 9.
The Patents, Designs, and Trade-marks Act, 1921–22.
FORM OF APPLICATION UNDER REGULATION 34 TO VACATE
ENTRY OF NAME OF MORTGAGEE OR LICENSEE IN
REGISTER.

Design No. , Class .
Name of registered proprietor : .
Place of business : .
Description : .

I, THE undersigned, , of [or I, the under-
signed, , a member of the firm of , of ,
on behalf of my said firm], apply that the entry of my [our]
name in the Register of Designs as of the Design
No. in Class may be vacated.
Dated this day of , 19 .
[Signature.]

To the Registrar, Patent Office, Wellington, New Zealand.

——
[Designs Form No. 10.
The Patents, Designs, and Trade-marks Act, 1921–22.
APPLICATION FOR ALTERATION OF ADDRESS, OR ADDRESS FOR
SERVICE, IN REGISTER OF DESIGNS.

Design No. , registered in Class .

I, , of , the registered proprietor of the
design numbered as above, apply that my address [or my
address for service] in the Register of Designs may be altered
to .
Dated this day of , 19 .
[Signature of proprietor.]

To the Registrar, Patent Office, Wellington, New Zealand.

——
[Designs Form No. 11.
The Patents, Designs, and Trade-marks Act, 1921–22.
FORM OF REQUEST FOR CORRECTION OF CLERICAL ERROR
IN AN APPLICATION TO REGISTER, OR FOR CORRECTION OF
CLERICAL ERROR UNDER SECTION 121.

I HEREBY request that

Dated this day of , 19 .
[Signature.]
[Address.]

To the Registrar, Patent Office, Wellington, New Zealand.