,327 REGISTRAR'S OFFICE, LESOTHO Form No.5 (Reg.35 (1) ) INDUSTRIAL PROPERTY ORDER APPLICA TION FOR REGIS­ TRA TION OF INDUSTRIAL DESIGN To: The Registrar Registrar's Office P.O. Box 33 Maseru For Official Use Date of Receipt by Registrar's Office: APPLICATION No.: (Office's Stamp) FILING DATE: Applicant's or agent's file reference: THE APPLICANT(S) REQUEST(S) THAT THE ACCOMPANYING IN­ DUSTRIAL DESIGN BE REGISTERED IN RESPECT OF THE FOLLOWING PARTICULARS: I. APPLICANT(S) (The data concerning each applicant must appear in this box or, if the space is insufficient, in the supplemental b Additional information is contained in supplemental box O Name: Address: Nationality: ' ..'.'''./ Country ", r-----. of~residence Telephone No.: II. or principal place of business: Telegraphic Address: Telex. No: AGENT The following agent has been appointed by the applicant(s) in the power attorney to be filed within one month accompanying this Form from the filing of this Form Name: D Address: D 01