SINGAPORE TRADE MARKS ACT / PATENTS ACT / REGISTERED DESIGNS ACT(CHAPTER 332 / 221 / 266)
TRADE MARKS RULES / PATENT RULES / REGISTERED DESIGNS RULESFORM HC4
Request for Ex Parte Hearing
Pre-requisites:
a. If you intend to attach any documents to this application, please have a copy of the said documents ready.
Estimated Time:
This form may take approximately 1 - 5 minutes to complete.
Generala. * denotes mandatory field.
b. For Patents, attention is drawn to sections 104 and 105 of the Patents Act, rules 90 and 105 of the Patents Rules, and the
Patents (Patent Agents) Rules 2001

PART 1

Reference
Applicant/ AgentReference
IPOS Reference(if applicable)

PART 2

Application No.*
Application No.*InternationalRegistration No.
(for Trade Marks only)

PART 3Name of Applicant/ Proprietor*

Note: If there is insufficient space, please use the continuation sheet in CS 4.

UEN/ Company Code(if applicable)

Name

Sole Proprietor orPartners' Name
(if sole proprietorship orpartnership)

PART 4

Details of Person filing this Request for Hearing*

Note: If the person(s) filing this request is/are the proprietor(s) mentioned in part 3 above, this part is to be left empty. If there isinsufficient space, please use the continuation sheet CS 1.

UEN/ Company Code(if applicable)

Name

V2.20210623

Page 1 of 5

Address

Singapore AddressThis Singapore address is to be used as the address forservice for the purposes of this application.
(Note: If this is crossed, it is not necessary to fill up the address for service inSingapore in part 6.)

Block/ HouseNo.
Street Name

Level - Unit-Building
Name
Postal CodeForeign AddressLine 1Line 2

Line 3Nationality or Country ofIncorporation*
State of Incorporation(mandatory for USAcorporations)

Country of Residency(mandatory for individuals)

Sole Proprietor orPartners' Name
(if sole proprietorship orpartnership)

V2.20210623

Page 2 of 5

PART 5Request Details*

Note : Please briefly describe the subject matter and/ or issues to be brought before the Registrar.

I/ We Hereby Request aHearing Before theRegistrar in Relation tothe Above Application in
Respect of*:PART 6

Contact Details*

Note:a. Where an agent with UEN is appointed, the fields for "Agent UEN/ Company Code", "Agent Name" and "Address forService in Singapore" should be completed. Where an individual or an agent without UEN is appointed, the sub-field“Representative or C/O Name” and "Address for Service in Singapore" should be completed instead.
b. The address for service in Singapore need not be filled up if the person's address in Part 4 is to be used as an address forservice in Singapore.
c. For the purpose of this proceeding, official correspondence will be sent to the address for service in Singapore as indicatedin this box, and must be the same as the one on our record.
d. Please file Form CM1 if you are a different agent or Form CM2 if you have changed your address for service in Singapore.

Agent UEN/ Company
CodeAgent Name

Representative or C/O
Name
Address for Service in Singapore
Block/ House
No.
Street Name

Level - Unit-

Building
Name
Postal CodeContact Person(if applicable)

Direct Telephone No.
(if applicable)

V2.20210623

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Email Address(if applicable)

PART 7

Attachments

Please attach any supporting documents.
PART 8Declaration*Declaration

By Person Filing the FormI, the undersigned, do hereby declare that the information furnishedabove is true to the best of my knowledge. I understand that I may beliable for criminal prosecution for providing any false information in thisapplication.

By Agent
I, the undersigned, do hereby declare that :i.

I have been duly authorised to act as an agent on behalf of theperson(s) filing this form.

ii.

The information furnished above on behalf of the person(s) filingthis form is true to the best of the person(s)' knowledge. I
understand that I may be liable for criminal prosecution forproviding any false information in this application.

Name

SignatureDate(DD/MM/YYYY)

No. of Extra Sheets
Attached to this Form

V2.20210623

sheet(s)Page 4 of 5

GST

GST INFORMATIONTax Invoice*Note:
Tax invoice will be issued to the entity/individual as indicated. Goods and Services Tax (GST)-registered businesses may claim
input tax with Inland Revenue Authority of Singapore (IRAS), subject to meeting the requirements under the GST Act.

The name of the requestor (as in Part 4 of this form) should be inserted in this field. If Part 4is left empty, please insert the name of the applicant/proprietor (as in Part 3 of this form).

Name (Tax invoice to beissued to)V2.20210623

Page 5 of 5