IPIN/lINGA/T/2 Page 96 49 TRADE MARKS ACT (FEE STAMP-ITEM Gd or 6e) Application by the Registered Proprietor or by any of the Registered Users of a Trade Mark for the cancellation of entry of a Registered User thereof (Section 34(5)(c)-Regularion 99). (To be accompanied by II Statement of the Grounds for the application) FORM Application is hereby made by (a) . being (b) the Registered Proprietor (a Registered User) of trade mark(s) No *registered in Class in respect of (c) . for the cancellation of the entry under the above-mentioned registration(s) of (d) . ............................................... . ") as a registered user of the trade markts) in respect of (e) .. The grounds of this application are set forth in the accompanying statement. DATED this day of (I) 19 .. . To: The Registrar of Trade Marks, Federal Ministry of Trade and Tourism, Abuja, Nigeria. *Additional numbers may be given in a signed Schedule on the back of the Form. (a) Here insert the full name, description and trade or business address of the applicant or of the applicants. (h) Strike out the words that are not applicable. (c) Here insert the specification in the register. (d) Here insert the full name, description and trade or business address of the registered user whose entry is sought to be cancelled. (e) Here insert goods in respect of which that registered user is entered. (f) Signature(s).