by whom the trade mark was then used in respect of the following goods, namely …………………………………………………………………………………….. all in circumstances that are stated fully in the accompanying statement of case, for the approval by the Registrar of the aforesaid transmission. Dated this ……………………… day of ……………………………… 200………. (10) …………………………………………….. Assignee’s address for service in Malawi is:…………………………………………………….. …………………………………………………….. …………………………………………………….. The Registrar The Trade Marks Office, P.O. Box 100 BLANTYRE