Click Here & Upgrade PDF Complete Expanded Features Unlimited Pages Documents Form D17 Request for grounds of decision (Regulation 28) (Lodge in duplicate) Date of lodgement: Design application/registration No Full name(s) of applicant(s): Class(es): Date of hearing: I hereby request the registrar to state in writing the grounds for his decision at the above hearing, and the facts relied upon to arrive at such decision. Date: _______________________________ APPLICANT/APPLICANT'S AGENT Address for service: FOR OFFICIAL USE ONLY Official date stamps The grounds for the registrar's decision and facts relied upon are as follows/are attached: