Rev. 2009] CAP. 506 Trade Marks 113 [Subsidiary] To: The Registrar of Trade Marks FORM TM 22 L.N. 146/2003. Application To Surrender Trade Mark For Some Goods And Services (rule 84A (1) (b)) In the matter of Trade Mark No. …………………………………………….. Class: …………………………………………. Name of registered proprietor: ………………………………......... Trade or business address: …………………………………............ Description of trade mark: ………………………………………… I, the proprietor of the trade mark described above, apply to surrender the trade mark in respect of the following goods or services: ………………………………………………………………………………… ………………………………………………………………………………… ………………………..……………………………………………………..... Names and addresses of persons with a registered interest in the trade mark: ………………………………………………………………………………… ……………………………………………………………………………........ ……………………………………………………………………………….... Attached to this application is a certification by the proprietor that each person with a registered interest listed above either – (i) has been given notice of the proposed surrender at least ninety days before the application is made; or (ii) is not affected by the surrender or has consented to it. Date: …………………………………………. Signature: ……………………………………… To: The Registrar of Trade Marks. FORM TM 23 L.N. 146/2003. Application To Enter Disclaimer Or Memorandum In Register (rule 85 (2))