Regulation 42 (1) FORM TM 5 THE REPUBLIC OF UGANDA FEE: THE TRADE MARKS ACT, 2010 Application for Registration of Certification Trade Mark ( Regulation 42(1 ) (To be filled in triplicate) To: One representation to be fixed within this space and six others to be sent on separate Forms TM No.3. The Registrar Of Trade Marks, P. O Box 6848, Kampala. Representation of a larger size may be folded, but must then be mounted upon linen or other suitable material and affixed hereto. (a) Here specify the goods. Only goods included in one and the same class should be specified. A separate application Form is required for each class. Application is hereby made for Registration in Part A of the Register of the accompanying Certification Trade Mark in Class ……………………………. in respect of (a) ……………………………………………………………… in the name of (b) ……………………………………………………………… whose address is (c) …………………………………………………………. ………………………………………………………………………………… Dated this ………………………… day of …..……………………… 20…… (b) Here insert the full name, description and nationality of the applicant. If the applicant is a body corporate, the kind and country of incorporation should be stated. (c) Here insert the full address of the applicant. (d) Signature. (d)………………………………………………………………………………. 2040