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, European Funds and Lands, 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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