61 TRADE MARKS REGULATIONS, 1970 (L.I. 667) Form TM—No. 17 TRADE MARKS REGULATIONS, 1970 Fee: N ¢ 5.00 APPLICATION TO THE REGISTRAR UNDER SECTION 23 (5) AND REGULATION 26 (2) TO DISSOLVE THE ASSOCIATION BETWEEN A REGISTERED TRADE MARK AND (AN) OTHER REGISTERED TRADE MARK(S) To be accompanied by a Statement of Case IN THE MATTER OF Trade Mark No............................................................................................................................. registered in Class ....................................................................................................................................... ........................ I (or We),............................................................................................................................... .............................................. ...................................................................................................................................... ...................................................... being the registered proprietor(s) of the above-numbered trade mark, hereby apply that the association of this trade mark with the following trade mark(s) registered in my (our) name: No. .......................................................... ............................................. registered in Class No. .......................................................... ............................................. registered in Class may be dissolved and the Register amended accordingly. The grounds for this application are set forth in the accompanying Statement of Case. Dated this ...................................................... day of ....................................... 19 ................................... (Signature) ................................................................................... To The Registrar of Trade Marks,