Patents Act, 1978 (Act No. 57 of 1978)RegulationsPatent Regulations, 1978SchedulesSchedule 2Form P21 |
Form P21
REPUBLIC OF SOUTH AFRICA
PATENTS ACT, 1978
APPLICATION FOR THE VOLUNTARY SURRENDER OF A PATENT
(Section 64(1) - Regulation 67)
R20 Official date stamp |
Patent No. |
Lodging date |
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21 |
01 |
22 |
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Full name(s) of patentee(s) |
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Full address(es) of patentee(s) |
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Title of invention |
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54 |
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I/We,…………………………………………………………………………………………………….................................................................
..................................................................…………………………………………………………………………………………………………..
hereby declare that—
| 1. | I/We am/are the patentee(s) mentioned above; |
| 2. | I/We hereby offer to surrender the above-mentioned patent; |
| 3. | No action for infringement or proceedings for revocation of the patent are pending; and |
| 4. | My/our reasons for making this offer are as follows |
……………………………………………………………………………………………………..............................................................
74 |
Address for service |
Dated this…………………………………………………… day of………… 20…………
………………………..…
Signature