The Laws of Zambia REPUBLIC OF ZAMBIA Designs Form No. 14 Section 22 (1) Regulation 19 (1) (a) THE REGISTERED DESIGNS ACT Fee APPLICATION UNDER REGULATION 19 BY ASSIGNEE, MORTGAGEE OR LICENSEE TO ENTER SUBSEQUENT PROPRIETORSHIP OR INTEREST IN DESIGN IN THE REGISTER I/We (1) .............................................................................................................................................................................. (1) Stat name a .................................................................................................................................................................................................... addres .................................................................................................................................................................................................... hereby request that you will enter my/our name(s) in the register as proprietor(s)/ mortgagee(s)/licensee(s) of the design No. ................................................................................................................................ I am/We are entitled to the said design (or to a share or an interest in the said design) in pursuance of (2) .......................................................................................................................................................................... (2) Inse particu .................................................................................................................................................................................................... the inst .................................................................................................................................................................................................... if any Dated this ................................................................................................day of .........................................., 19 ............. (3) .............................................................................................. My/Our address for service in Zambia: (3) To b signed .................................................................................................... applica his/thei .................................................................................................................................................................................... .................................................................................................................................................................................... .................................................................................................................................................................................... The Registrar, The Designs Office, Lusaka, Zambia. NOTE.-The instrument under which the applicant claims should accompany this form. Copyright Ministry of Legal Affairs, Government of the Republic of Zambia