326 Form No.4 (cont'd) IV. ADDITIONAL INFORMATION The following items accompany this Form: - evidence that the owner of the patent/utility model certificate* has received a request from the applicant to obtain a licence but that the applicant has been unable to obtain such a licence on reasonable terms and within a reasonable time; - plan according to which the applicant intends to work the invention, including evidence that he has the ability to do so in Lesotho. D Other (specify) VII. SIGNATURE(S)** (Applicant(s)/ Agent) * ** (Date) Delete whichever does not apply. Type name(s) under signature(s) and delete whichever does not apply. (Form No.4, second and last page)