IPIN/lINGA/T/2 Page 72 25 TRADE MARKS ACT (FEE STAMP-ITEM 18) Request by Registered Proprietor of a Trade Mark that a Disclaimer or Memorandum relating thereto may be registered (Regula/ion 86) FORM Request is hereby made by (a) . ........................................................................................ . of . for the addition to the entry in the Register in connection with Trade Mark No in Class . of the following namely . ........................................................................................ . DATED this ........... day of (b) 19 . . To: The Registrar of Trade Marks, Federal Ministry of Trade and Tourism, Abuja, Nigeria. (a) Here insert the name, trade or business address and description of the Registered Proprietor. (h) Signature.