337 Form No. 10 (cont'd) Nationality: Country of residence or principal place of business: Telephone No: Telegraphic Address: Telex No.: * Delete whichever does not apply. Indicate application or title concerned. ~* V. ADDITIONAL INFORMATION The following items accompany this Form: D D the original or a certified copy of the document evidencing the change of ownership, signed by or on behalf of the contracting parties other documents evidencing the change in ownership (specify) Dfees D D other (specify) approval of the Minister* VI. SIGNATURES** ....................................... . (New Applicant(s)/New Owner(s) ) (Date) ........................ (Applicant(s)/Owner(s) ) (Date) * Required where the request is in respect of a collective mark. ** Type name(s) under signature(s) and delete whichever does not apply. (Form No. 10 second and last page) :