/ INDUSTRIAL DESIGNAPPLICATION FORM
Send your Application Form to:
Legal Strategy & Intellectual Property
Group Strategy (GS)
Telekom Malaysia Berhad
Level 45, South Wing, Menara TM, JalanPantai Baharu, 50672 Kuala Lumpur
For LSIP Use / Date Received:
LSIP Ref. No.:
SECTION A: IMPORTANT NOTES
  1. This form is for the registration of a single work and must accompany the hard copy which contains the work to be registered. The fields in this form marked with a asterisk *must be completed to enable accurate registration of the work.
  2. It is the applicant’s responsibility to ensure the accuracy of the included information.
  3. Please tick (√), wherever relevant.
  4. Application will only be processed after receiving complete information and/or documentation.
  5. All personal information provided in this form have been given by the author(s) and/or the applicant and shall be used by LSIP for purpose of processing this application and also for all other purposes that are necessary and required in relation to the copyright protection.
  6. Please refer to the followings policies, manual and guidelines for further understanding on Intellectual Property (IP), which are available at TM1Intra
(a)Business Process & Governance (BPG)
(b)IP Manual
(c)Booklet on IP Series
(d)FAQ
7. Please submit this applicationform together with the following;
i.All relevant documentation (1 copy each) - e.g. the product write-up, product specification, drawing, etc;
ii.NRIC copies (1 copy each) of all related inventors (internal & external);
iii.Any relevant contract/s, passing of right from outside party/ies (if any).
SECTION B: PARTICULARS OF THE OWNER AND THE WORK
1. / Particular of the Owner(s): *
Note: Enter the name of the owner. To add additional owner, please add further to continue.
[For TM, kindly leave blank as LSIP shall complete the details] / Name:
Company Registration No.:
Registered Address:
Authorised Personnel:
Name:
Designation:
Staff No.:
Identity Card/Passport No.
Nationality:
Division:
Correspondence Address:
Note: Authorised personnel to execute the Statutory Declaration Form and other relevant documentation
2. / Relationship between inventor and applicant / Employer to the inventor – invention done under commission / during working hours. For joint work, please supply the contract with third party.
3. / Title of the article
(please provide clear & concisetitle indicating the article)
4. / Project Title (if any)
5. / Project No. (if any)
6. / Development ofthe article:
  • Date start and complete
  • Location

7. / Description of the article
8. / Have this invention been disclosed elsewhere before?
If yes, please specify mode of disclosure, title, name of the publisher, date of the disclosure, name of the author, who are the audience etc. (if applicable)
9. / Priority Date & Priority Application No.
(if the design are related to other design registered anywhere)
10. / If applicant for priority application was not the same entity with item 1, then deeds of assignment / instrument for right to apply must be submitted
11. / Date of first used in Malaysia
12. / Classification
(name the class/subclass based on International Classification)
13. / Disclaimer (if any) on words, letters or numerals appear in the design
14. / Product drawing –Please attach front view, back view, top view, bottom view, perspective view, plan view, cross-sectional view of the drawings.
15. / Describe on how the invention works by referring to the drawings, sketches, charts or photos of the invention, where appropriate - drawing should be referred to by the numbered part
16. / Describe the advantages of the invention with assistance of the drawings, sketches, charts or photos of the invention where appropriate - drawing should be referred to by the numbered part
17. / Is there any Logo/ mark associate with this invention?
(please provide if any)
18. / Please attach any related supporting documents (if any)
SECTION C: PARTICULARS OF THE AUTHOR(S), IF APPLICABLE
Particulars of inventor (s):
  • Fullname
  • Address (must be valid at least 5years)
  • Nationality of eachinventor
(please provide certified copy of NRIC for eachinventor) / Name:
Designation:
Staff No.
Identity Card/Passport No.
Nationality:
Address:
Employer Name:
Employer’s Registered Address:
Please add further to continue.
SECTION D: DECLARATION

I/We hereby declare that the particulars given in this form are true, up to date and accurate and should there be any changes to any personal information or data set forth herein, I/ we shall update LSIP accordingly.

Main Author or Requestor
……………………………………………… / Approver
……………………………………………… / Complete form received by LSIP:
…………………………………………
Name:
Designation:
Date: / Name:
Designation:
Date: / Name:
Designation:
Date:

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