Form D.T. No. 4
Section 21
Rule 11 (1)
THE REGISTERED DESIGNS ACT
Fee units: 12
REFERENCE TO THE TRIBUNAL UNDER SECTION 21 OF THE ACT
IN THE MATTER of a reference by (1)
(1) State
the name
of
claimant(s)
and nature
of matter
in dispute
against
(2)
(2) State
name of
other party
to dispute
I/We (3)
(3) State
full name
and
address of
claimant(s)
hereby refer for the determination of the Tribunal my/our claim against (4)
(4) State
full name
of
respondent
The following are the grounds on which I/we base my/our claim:
(5)
Dated this
(5) Here
state
briefly the
nature of
the
grounds
day of .........................................., 19 .............
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