IP/Nil /NG AfT/2 Page 81 (a) Here insert the full name and trade or business address of the person making the request. (h) Cancel words in italics that are not applicable and strike out one of the words "Proprietor" or "User" as the case may be. "Additional numbers may be given in a signed Schedule on the back of the Form. (c) Cancel words that are not applicable. (d) State here the precise entry or changed entry desired. (e) Signature. Here insert the name of the public authority ordering the change and the date thereof. (g) Signature of the Registered Proprietor or Registered User, as the case may be. en