Regulations 55 and 57 FORM TM 15 FEE: THE REPUBLIC OF UGANDA THE TRADE MARKS ACT, 2010. Request to the Registrar to register a subsequent Proprietor of Trade Mark or Trade Marks upon the same devolution to Title (Regulations 55 and 57) To: Registrar of Trade Marks, P.O. Box 6848, Kampala. I (We) (a) …………………………………………………………………… ………………………………………………………………………………… ………………………………………………………………………………… (a) Here insert full name, trade business or address, nationality and description. Hereby request that my (our) name(s) may be entered in the Register of Trade Marks as proprietor(s) of Trade Mark(s) No(s) ………………………..* in *Additional numbers Class…………….as from the………………………………………………… (b) Number acquisition (date of acquisition of proprietorship) of of proprietorship I am (We are) entitled to the Trade Mark(b) by virtue of (c) (c) Here insert full ………………………………………………………………………………… ………………………………………………………………………………… ………………………………………………………………………………… ………………………………………………………………………………… ………………………………………………………………………………… particulars of the instrument of assignment or transmission, if any, or statement of case. (d) Strike out any word not applicable (d) The Trade Mark at the time of the assignment was used/not used in a business in the goods in question, and the assignment took place/did not take place on or after the appointed day otherwise than in connection with the goodwill of a business in the goods/and there is a copy of the Registrar's direction to advertise the assignment, a copy of each of the advertisement complying therewith and a statement of the dates of issue of any publications containing them. Dated this…………………….day of ……………………………20…… …………………………………….……………(Signature) Applicant 2050 (See reg.69)

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