Case was (were) in respect of the following goods, namely…………………… ……………………………………………………………………………….. ……………………………………………………………………………… and on the (f) …………………..day of ……………………………20……… transmitted to (g) him (to(h) …………………………………………………. ……………………………………………………………………………….. of ……………………………………………………………………………… by whom the Trade Mark was then used in respect of the following goods namely ..…………………………………………………………………….all in circumstance that are stated fully in the accompanying statement of Case, for the approval by the Registrar of the aforesaid Transmission. Dated the ……………………….day of…………………..20 …………….. (j)…………………………………………………………………………… (f)Insert here the date of the Transmission which must no proceed the appointed day. (g)Strike out the words that are not applicable. (h)Insert here the name and trade or address of the predecessor in title if any. (i)Insert here the name address of the person who transmitted. (j) Signature To: Registrar of Trade Marks, P.O. Box 6848, Kampala. 2075