Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694499797372.pdf (Antigua and Barbuda)
SCHEDULE 2 (Regulation 4) FORMS REGISTRAR’S OFFICE, ANTIGUA AND BARBUDA Form No.

1 THE INDUSTRAL DESIGNS ACT, 2003 APPLICATION FOR REGISTRATION OF INDUSTRIAL DESIGN To: The Registrar Antigua and Barbuda For Officials Use Date of Receipt by Registrar’s Office APPLICATION No: (Office Stamp) FILING DATE ____________________________ Applicants or Representatives File Reference THE APPLICANT(S) REQUEST THAT THE ACCOMPANYING INDUSTRIAL DESIGN BE REGISTERED IN RESPECT OF THE FOLLOWING PARTICULARS: I.
Applicant(s) (the data concerning each applicant must appear in this box or, if the space is insufficient in the supplemental box.

Additional information is contained in supplemental box.

Name………………………………………………………………………………………………………………………………………… Address……………………………………………………………………………………………………………………………………….
Nationality………………………………………………………………………………………………………………………………… Country of Residence or principal place of business: ………………………………………………………………………………………………………………………………………………… Telephone……………………………… Fascimile ……………………………….

Email ………………………………….

II.


AGENT The following agent has been appointed by the applicant(s) in the power of the attorney accompanying this Form to be filed within one month from the filing of this Form Name………………………………………………………………………………………………………………………………………… Address……………………………………………………………………………………………………………………………………….

Telephone……………………………… Facsimile ……………………………….

Email ………………………………….

III.


REPRESENTATIONS OF THE INDUSTRIAL, DESIGN SPECIMEN This Form is accompanied by: Four graphic representations Four drawings or tracings A specimen of the industrial design IV.

PRODUCTS The kind of products for which the industrial design is to be used is (are) the following: V. PRIORITY CLAIM (if any) The priority of an earlier application is claimed as follows: Country : ………………………………………………………….
Filing Date: ……………………………………………………………………… Application No: The priority of more than one earlier application is claimed, the data are indicated in the supplemental box.

The certified copy of the earlier application.

Accompanies this Form Will be furnished within three months of the filing of this Form.

VI.

FEES accompanying this form VII.

SUPPLEMENTAL BOX* ……………………………………………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………………………….


VIII.

Signature ……………………………...................................... ...................................................... (Applicant/Agent) (Date) Print Name …………………………………………………………….. Applicant/Agent (To be filled in by the registrar) 1.

Date application received: ……………………………………………………………………………………………………………….. 2.
Date of receipt of corrections, later filed papers completing the application: …………………………………………………………………………………………………………………………………………………….….. 3.

Date fees received: …………………………………………………………………………………………………………………….…… * Use this box if any of the boxes is not large enough to contain information to be furnished.

Indicate the boxes continued in this box by their Roman numerals and title (e.g.

** Type name(s) under signature and delete whichever does not apply.