44 TRADE MARKS REGULATIONS, 1970 (L.I. 667) Form TM—No. 4 TRADE MARKS REGULATIONS, 1970 Fee: N ¢ 5.00 APPLICATION FOR REGISTRATION OF CERTIFICATION TRADE MARK UNDER SECTION 36 (To be accompanied by two extra duplicates) One representation to be affixed within this space and 4 others to be sent on separate Forms TM 2 (a). Representations of a larger size may be folded, but must then be mounted upon linen or other suitable material and affixed hereto. Application is hereby made for Registration in Part A of the Register of the accompanying Certification Trade Mark in Class .................... in respect of (a) ....................................... in the name of (b) ....................................................... whose address is(c) ....................................................................................................................................... .............. Dated this ............................................................ day of .................................19 ........................................... (Signature)...................................................................... To The Registrar of Trade Marks, Registrar-General's Department P.O. Box 118, Accra. ______________ (a) Here specify the goods. Only goods included in one and the same class should be specified. A separate application form is required for each class. (b) Here insert the full name, description and nationality of the applicant. If the applicant is a body corporate, the kind and country of incorporation should be stated. (c) Here insert the full address of the applicant.