319 SECOND SCHEDULE (Reg. 3 (I) ) FORMS REGISTRAR'S OFFICE, LESOTHO Form No. J (Reg.9(1) ) INDUSTRIAL PROPERTY ORDER For Official Use REQUEST FOR GRANT OF PATENT OR UTILITY MODEL CERTIFICATE Date of Receipt by Registrar's Office: To: The Registrar Registrar's Office P.O. Box 33 Maseru 100 Application No: (Office's Stamp) FILING DATE: Applicant's or agent's file reference: D THE APPLICANT(S) REQUEST(S) THE GRANT OF A PATENT UTILITY MODEL CERTIFICATE IN RESPECT OF THE FOLLOWING PARTICULARS: D 1. TITLE OF INVENTION: . II. APPLICANT(S) (The data concerning each applicant must appear in this box or, if the space is insufficient, in the supplemental box.) Additional information is contained in supplemental box Name: Address: Nationality: Country of residence or principal place of business: Telephone No: 1I I . Telegraphic Address: Telex No: AGENT The following agent has been appointed by the applicant(s) in the powel of attorney to be filed within one month accompanying this Form from the filing of this Form Name: D D Address: Telephone No: IV. INVENTOR. The invetor is the applicant Additional information is contained -