On behalf of my said firm) ……………………………………………………………… …………………………………………………………………………………………… for the striking out of (2) ……………………………………………………………….. from the goods for which the trade mark No. ……………………………………… is registered in Class ………………………………………………….. (2) Here designate the goods to struck out. Dated this ……………………….. day of ………………………………….. 200……… (3) Signature. (3) …………………………………………….. 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. 25 Section 39(1). Regulations 85, 86 and 87. TRADE MARKS ACT (CAP. 49:01) Fee: 10s. Request by Registered Proprietor of a Trade Mark that a Disclaimer or Memorandum relating thereto may be Registered. Request is hereby made by (1) of …………………………………. For the addition to the entry in the register in connection with trade mark No. …………….. in Class. ………………………………………… of the following ………………………………………….. namely: ……………………………………………………………………………………………. ……………………………………………………………………………………………. ……………………………………………………………………………………………. ……………………………………………………………………………………………. (1) Here insert the name, trade or business address and description of the registered proprietor. Dated this ……………………….. day of ………………………………….. 200……… (2) Signature. (2) ……………………………………………..