102 [Subsidiary] L.N. 146/2003. CAP. 506 [Rev. 2009 Trade Marks 2. Application is hereby made for registration of the above trade mark as (check one): a trade mark other than a trade mark listed below a certification trade mark a defensive trade mark (if a defensive trade mark is applied for a statement of case and statutory declaration as required under r. 36 (1) must accompany this application) a collective trade mark (if a collective trade mark is applied for a copy of the rules governing the use of the trade mark must accompany this application) 3. * Class Goods/Services 4. Additional information, if any* …………………………………………… ………………………………………………………………………… ………………………………………………………………………… 5. Proposed proprietor Name: ………………………………………………………………….. Trade or business address: …………………………………………….. ………………………��………………………………………………. Trading style (if any): ………………………………………………. *Applicant may use separate sheet where necessary Date: …………………………………… Signature: ……………………………… To: The Registrar of Trade Marks.