331 REGISTRAR'S OFFICE, LESOTHO Form No.7 (Reg. 41, 42 & 43) For Official Use INDUSTRIAL PROPERTY ORDER Date of Receipt by Registrar's Office APPLICATION FOR REGIS­ TRATION OF A MARK Application No: (Office's Stamp) To: The Registrar Registrar's Office P.O. Box 33 Maseru FILING DATE: Applicant's or agent's file reference: 1. THE APPLICANT(S) REQUEST(S) THE REGISTRATION OF A MARK IN RESPECT OF THE FOLLOWING PARTICULARS: Name(s): Address(es): Nationality: Country of residence or principal place of business: Telephone No.: II. Telegraphic Address: Telex No.: AGENT The following agent has been apointed by the applicant(s) in the power of attorney D accompanying this Form D to be filed within one month from the fIling of this Form Name: Address: Telephone No.: III. COLLECTIVE MARK D D This application for registration concerns a collective mark. The conditions governing the use of a collective mark are attached.