328 Form No.5 (cont'd) Telephone No.: 111. CREATOR The creator is the applicant D Additional information is contained in supplemental box D If the creator is not applicant: Name: Address: The statement justifying the applicant's right accompanies this Form D IV. REPRESENTATIONS OF THE INDUSTRIAL DESIGN, SPECIMEN This Form is accompanied by: D four graphic representations D four drawings or tracings D a specimen of the industrial design V. PRODUCTS The kind of products for which the industrial design is to be used is (are) the following: VI. PRIORITY CLAIM (if any) The priority of an earlier application is claimed as follows: Country: Filing Date: Application No.: The priority of more than one earlier application is claimed; the data are indicated in the supplemental box D The certified copy of the earlier application accompanies this Form D D will be furnished within three months of the filing of this Form VII. FEES accompany this Form D -