Trademarks Form Tm 17

FORM TM- 17 

THE TRADE MARKS ACT, 1999 

Age nt s  Code  N o: 

Pr opr ie t or s  Code  N o: 

Fee: Rs.2500 for the first trade mark and Rs.500 for every additional trade mark 
included in the assignment 

Application for the certificate of the Registrar under Section 40(2) with reference to 
a proposed assignment of a registered trade mark, rule 77. 

(To be accompanied by a statement of case in duplicate and a copy of the proposed 
assignment)  

In the matter of Trade Mark(s) No(s)___________________________________________________________registered in 
the name of ____________________________________________________________________in class 
(es)___________________________________ 

Application is hereby made by ' ________________________________________________being the registered 
proprietor (s) of the abovementioned registered trade mark(s) for the Registrar's certificate 
under section 40(2) with reference to a proposed assignment of the registered trade mark(s) 
No.(s)_______________. to[2____________________________ in circumstances that are stated fully in the 
accompanying statement of case.  

All communications relating to this application may be sent to the following address in India:-   

Dated this ____________________.day of ________20_________ 

3__________________________ 

SIGNATURE 

NAME OF SIGNATORY IN LETTERS 

To 

The Registrar of Trade Marks 

The Office of the Trade Marks Registry at [4 _________________ 

1. Insert the full name and address of the registered proprietor. 

2. Insert the full name, address and nationality of the proposed assignee. 

3. Signature of the registered proprietor or of his agent. 

4. State the name of the place of the appropriate office of the Trade Marks Registry. 

(See Rule 4).