FORM TM-12

THE TRADE MARKS ACT, 1999

Renewal of registration of Trade Mark

[ Section 25, Rules 63(1), 132(b) and 138(3)]

We, ___________________ having registered office at ___________________,

hereby leave the prescribed fee of Rs. 5,000/- for renewal of registration of the

Trade Mark No. __________ in Class _______.

The notice of renewal of the registration may be sent to the following address in
India:

Dated this _______day of ____________ 2005.

For _____________________________

_________________________
Authorised Signatory

To
The Registrar of Trade Marks,
The Office of the Trade Marks Registry at MUMBAI

Code No.