Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697797751270.pdf (Dominica)
COMMONWEALTH OF DOMINICA MARKS, COLLECTIVE MARKS AND TRADE NAMES ACT NO.

12 OF 1999 TRANSFER DOCUMENT In respect of registration(s) and/or Application(s) of registration of mark(s) (Regulations 43(1) (d)) FORM 10 Fees payable in terms of Schedule 1 to the Regulations OFFICIAL DATE STAMP FOR OFFICIAL USE ONLY 1.

Declaration of Transfer The undersigned transferor(s) transfers (transfer) to the undersigned transferee(s) the ownership of the registration(s) and/or application(s) indentified below.

2.
2.

Registration (2) and/or Application(s) concerned The present document concerns the transfer of the following registration(s) and/or application(s): 2.1 Registration number(s) 2.2 Application numbers (s):1 2.3 If the spaces under 2.1 or 2.2 are not sufficient, check this box and provide information on an additional sheet.

3.

Goods and/or Services Affected by the Transfer 3.1 and/or registration(s) referred to in item 2are affected by the transfer.
Check this box where all the goods and/or service listed in the application(s) 3.2 Check this box where item 2 mentions only one application or registration and where only some of the goods and/or services listed in that application or registration are affected by the transfer and indicate the goods and/or services that have been affected by the transfer.
3.3 Check this box where item 2 mentions more than one application or registration and if in respect of at least one of them the transfer affect less than all the goods and/or services listed.

In this case, indicate on an additional sheet, separately in respect of each application and/or registration, whether the transfer affected all the goods and/or services or only some of them.
In respect of any application or registration where only some of the goods and/or services that are affected by the transfer, make the indication in the way specified in item 3.2.

4.
Transferor(s) 4.1 If the transferor is a natural person, the person’s family or principal name.2 (a) (b) given or secondary name(s).2 4.2 If transferor is a legal entity, the entity’s full official designation 4.3 Address (including postal code and country): Telephone number(s): Facsimile number(s) Email Address (with the area code) (with the area code) 4.4 Check this box if there is mote than one transferor; in that case, list them on an additional sheet and indicate, in respect of each of them, the data referred to in items 4.1 or 4.2 and 4.3.
5.
Transferee(s) 5.1 If the transferee is a natural person, the person’s family or principal name 3 (a) (b) given or secondary name(s) 3 5.2 If the transferee is a entity, the entity’s full official designation: 5.3 Address (including postal code and country): Telephone number(s): Technical number(s) Email Address (with the area code) (with the area code) Check this box if there is mote than one transferee; in that case, list them on an 5.4 additional sheet and indicate, in respect of each of them, the data referred to in items 5.1 or 5.2 and 5.3.
6.

Additional Indications (see the Annex to this Form (attached)) (the furnishing of any of those indications is optional for the purpose of recordal of the change in ownership.

Check this box if the Annex is used.

7.

Signatures 7.1 signature(s) of the transferor(s) 7.1.1 Name(s) of the natural person(s) who sign(s): 7.1.2 Date of signature(s): 7.1.3 Signature(s) 7.2 Signature(s) of the transferee(s) 7.2.1 Name(s) of the natural person(s) who sign(s): 7.2.2 Date of Signature(s) 7.2.3 Signature(s): 8.
Additional sheets and attachments: Check this box if additional sheets and/or attachments are enclosed and indicate the total number of such sheets and/or attachments.

Check this box if an Annex is enclosed and indicate the number of the pages of the Annex and the number of any additional sheets to the Annex.

Additional Indications Relating To a Transfer Document (Item 6) A.
Transfer of Goodwill or Business (a) (b) (c) Check this box where the transfer is made with the relevant goodwill or the business in respect of all the goods and/or services listed in the application(s) and/or registration(s) referred to in item 2 of the transfer document.
Check this box where item 2 of the transfer document mentions only one application or registration and where the transfer is made with the relevant goodwill or the business in respect of only some of the goods and/or services listed in that application or registration and indicate the goods and or services in respect of which the transfer is made with the relevant goodwill or the business.
Check this box where item 2 of the transfer document mentions more than one application or registration and if in respect of at least one of them the transfer is made with the relevant goodwill or the business in respect of less than all the goods and/or services listed.
In this case, indicate an and additional sheet, separately in respect of each application and/or registration, whether the transfer is made with the relevant goodwill or the business in respect of an application or registration where the transfer is made with the relevant goodwill or the business in respect of only some of the goods and/or services, make the indication in the way specified in item (b).

B.
B.

Transfer of Rights Resulting from Use The rights, arising from the use of the mark, are transferred in respect of (a) (b) all registration(s) and/or application(s).

Only the following registration(s) and/or application(s) C. Transfer of the Rights to Sue The transfer shall have the right to sue for past infringements.

D. Consideration (a) The transfer is affected in consideration fro money received.
(b) The transfer is effected in consideration for money received and other goods and valuable consideration.

E. Effective Date of the Transfer (a) (b) The transfer is effective as of the date of signature of the present transfer document.
The transfer is effective as of the following date:………………………………………… 1 Where the application number of an application has not yet been issued or is not known to the transferor or its representative, that application may be identified by furnishing either: (i) a copy of the application, or (ii) a representation of the mark, accompanied by an indication of the date on which, to the best knowledge of the transferor or its representative, the application was received by the Office and an identification number given to the application by the transferor or its representative.
2 The names to be indicated under (a) and (b) are those which were indicated in the application(s), or are recorded in respect of the registration(s), to which the present documents relates.

3 The names to be indicated under (a) and (b) are either the full names of the transferee or the names customarily used by the transferee.