ID FORM 1
INTELLECTUAL PROPERTY CORPORATION OF MALAYSIA
Industrial Designs Act 1996 Industrial Designs Registration Office
Industrial Designs Regulations 1999
(Section 14 and Regulation 5)
APPLICATION FOR REGISTRATION OFAN INDUSTRIAL DESIGN
Application number (For official use only):
1.Full name and address of / each applicant:
(Names of individuals including all partners in a firm shall be given in full. Underline the surname or family name. For a corporate body give its company name). If the applicant is a
corporate body, give country / state of incorporation.
2.Fullname andaddressoftheauthor:
3.Nameofagent(ifapplicable):
Addressfor service inMalaysiatowhichcorrespondence shouldbesent:
(If agent is appointed, Form ID 10 shall be submitted together with this form)
4.Namethe particulararticleorsetofarticles towhichthedesign applies:
5. Classification:
Enter the class and subclass number in accordance with the International Classification for Industrial Designs.
6. View(s):
Enter the number(s) and which view(s) to be gazetted.
7. Multiple applications: Enter the number of industrial design applied for registration (if any):
8.Association:
Entertheapplication numberorregistrationnumberoftheearlierdesignwithwhichtheapplicantseeksassociationundersection23andregulation17.
- Declarationofpriority(ifany):
Givetheconventioncountryandfilingdateofanypreviousapplicationmadeabroadfromwhich priority isclaimedundersection 17.
Country:
Number:
Date of filing:
10.Ifthedetailsincolumn9applies,andtheprevious applicationwas notmadeinthename(s)given in column1,givedetailsoftheinstrument(forexample,deedofassignment)which givestheapplicant therighttoapplyforregistration.Includeappropriate name(s)anddate(s):
(If thisinformationisnotgivenatthetimethis Formisfiled,youmustsubmititbeforethis industrial designisregistered).
11. Divisionalapplication:Givethenumberandfilingdateofanyrelevantearlierapplication whosefiling dateisclaimed undersection20.
Number:
Dateoffiling:
12.Declaration:
I /Weapplytoregisterthe industrial designshown intheaccompanyingrepresentations.I /Wedeclare thatI /Wetheapplicant(s)who claim(s)tobethe owner(s) ofthedesignin relationtothe articleorsetof articlesspecifiedincolumn4andto betheownerofany designsrightthatexistsinthisindustrialdesign. I /Wealsodeclare inrespectofany entry incolumn9thattheapplicationmade intheconvention countryuponwhichthe applicantreliesisthe firstapplicationmadeforregistrationofthedesignina convention country.
Signature(s)Date
Name of applicant / agent
(Deletewhicheverisnotapplicable)
13.Name andtelephonenumberofpersontocontactinMalaysia: