Click Here & Upgrade PDF Complete Expanded Features Unlimited Pages Documents Form D10 Payment and certificate of renewal (including a request for extension) (Section 22 - Regulation 34) (Lodge in duplicate) Date of lodgement: Application No.: Renewal date: Full names) of applicant(s): Type of design Part A Part F The undermentioned amounts) is(are) forwarded herewith: 1. The amount of R ______in respect of a renewal fee is hereby paid to keep the above design in force for another period of_______ years from the above-mentioned renewal date. 2. The amount of R ______is hereby paid and you are requested to grant an extension of ________months for the payment of the renewal fee. 3. The amount of R ______is hereby paid in respect of outstanding annual fees after restoration of the design. Date: _______________________________ APPLICANT/APPLICANT'S AGENT Address for service: Receipt of the above amounts) is hereby acknowledged and by virtue of such payment the rights of the proprietor(s) remain in force for the period shown above. The request for extension of time is here granted/refused. Official date stamp ……………………. . NOTE: Fee payable in terms of Schedule 1 to the regulations GENERAL: The duplicate will be returned but is not valid unless endorsed with the official stamp.