......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... have appointed iii 2 ................................................................................................................ of ...................................................................................................................................... .......................................................................................................................................... to act as my (or our) agent for iv 3............................................................................................ .......................................................... No. ......................................................................... and request that all notices, requisitions and communications relating thereto may be sent to such agent at the above address. I (or We) hereby revoke all previous authorizations, if any, in respect of the same matter or proceeding. I (or We) hereby declare that I am (or we are) a v 4 .................................................................. Dated this .............................. day of .............................. 20........ vi 5 ...................................................................................................................................... Address vii 6 ......................................................................................................................... ......................................................................................................................................... (To be struck out if the person appointing the Agent desires his own address to be treated as the address for service after registration.) I (or We) also authorize the said viii 7 ..................................................................................... to complete Form TM/SM 28 requesting the entry of an address for service as part of any registration obtained under the above authorisation. Dated this .............................. day of .............................. 20........ ix 8 ...................................................................................................................................... Address x 9 .......................................................................................................................... ......................................................................................................................................... To: The Registrar of Trade/Service Marks, Dar es Salaam, Tanzania. FORM TM/SM 2 APPLICATION FOR REGISTRATION MARK IN THE REGISTER TANZANIA THE TRADE AND SERVICE MARKS ACT (CAP. 326) (Section 21 and Regulation 17) FEE SHS. 50,000/= xi 1 xii xiii 2 Application is hereby made for Registration in the Register of the accompaying Mark in Class ....................................... in respect of xiv 3 .......................................................................... ....................................................................................................................................... ....................................................................................................................................... .......................................................................................................................................