FORM IP 41

Regulation 64

THE INDUSTRIAL PROPERTY ACT, 2001

The Managing Director,

Kenya Industrial Property Institute.

PAYMENT OF ANNUAL FEE FOR AN AGENT

I ………………………………………………………………………………………………………
of …………………………………………………….…………………………………………………
…………………………………………………………………………………………………………
hereby submit the prescribed annual fee to maintain my admission to practice before the Institute for
the year………………

Dated at................................. this ................................. day of....................., 20.............

Signature ..................................................

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CERTIFICATE OF MAINTENANCE OF ADMISSION AS A PATENT AGENT

This is to certify that ……………………………………………..has paid the prescribed fee to

maintain his admission to practice before the Institute for the year…………………..

Dated at........................ this .................... day of..................., 20...........

Signature ……………………………………

Kenya Industrial Property Institute Stamp