e-form

Application for the Surrender of a Registered
Design or the Withdrawal of a
Design Application

WARNING to all applicants - Any false statements, misrepresentation or concealment of material fact on this form or any document presented in support of this application may be grounds for criminal prosecution.

INFORMATION PROTECTION – The Commerce Department within the Ministry for the Economy and Industry, collects and processes the personal data provided in this application to carry out its lawful functions under the Patents & Designs Act [Cap. 417].

All personal data is collected and processed in accordance with the General Data Protection Regulation 2016/679 and all current Data Protection legislation, the Patents & Designs Act [Cap. 417] and the Data Privacy Policy of the Department, a copy of which is available on our website.

Personal data provided in this application will only be shared with third parties according to the law.

Details of Registration /Application

Design Number





Filing Date





Details of Applicant

Full Name





Address





Postcode





Country





Telephone Number





Mobile Number





E-Mail





FOR OFFICE USE ONLY:

Receipt No.& Date:

Amount Paid:

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