The grounds for this application are set forth in the accompanying statement of case. Dated this ……………………….. day of ………………………………….. 200……… Signature. (1) …………………………………………….. The Registrar The Trade Marks Office, P.O. Box 100 BLANTYRE LAWS OF MALAWI Trade marks Trade Marks Regulations Cap. 49:01 (Subsidiary) MALAWI Form TM. No. 21 Section 39 Regulation 102. TRADE MARKS ACT (CAP. 49:01) Fee: 10s. Request for Correction of Clerical Error; or for Permission to amend Application IN THE MATTER OF (1) …………………………….……………………………. I/We, being the ……………………………………………..…………………………… hereby request that ………………………………………………………………………. ……………………………………………………………………………………………. ……………………………………………………………………………………………. ……………………………………………………………………………………………. ……………………………………………………………………………………………. (1) Here insert words and reference number identifying the entry or application. Dated this ……………………….. day of ………………………………….. 200……… (2) …………………………………………….. (2) Signature The Registrar