ETHIOPIAN INTELLECTUAL PROPERTY

AUTHORITY
Form No.7

Regulation No.12/1997
APPLICATION FOR REGISTRATION OF FOR OFFICE USE
INDUSTRIAL DESIGN
Date of Receipt by the Authority:
TO: The Ethiopia Intellectual Property Authority
Application No:
P.O.Box: 25322/1000
Filing Date:
Tel No: (251-115) 525972
Approved by: Name
Fax No: (251-115)529299
Signature:
E-mail: eipo@ethionet.et

Addis Ababa Office Stamp

Ethiopia

The Applicant(s) request(s) that the accompanying Industrial Design be registered in Respect of the following particulars:

I. Applicants(s)

The data concerning each applicant must appear in this box or, if the space is insufficient, in the
supplemental box

Name:

Address:

Nationality:

Country of Residence of Principal place of Business:

Tel No: P.O.Box

E-mail: Fax No.

(Form No 7 First Page)

 (Form No. 7Cont’d)
II. Agent

The following Agent has been appointed by the Applicant(s)

ThePowerof Attorney accompanies this form

The power of Attorney will be filed within on month form the filling of the form

Name:

Address:

Tel No: P.O.Box

E-mail: Fax No.

III. Representation of the Industrial Design; Specimen

This form is accompanied by:

Four graphic representations

For drawings or tracings

A Specimen of one of the industrial design

IV. Production

The kind of product (s) for which the industrial design is or are to be used is/ are the following

V. Priority Claim (if any)

The priority of an earlier application is claimed as follow:

Country: filing Date:

Application No:

Thepriority of more than one earlier application is claimed: the data re indicated in the supplemental box

The certified copy of the earlier application:

Accompanies this form

Will be furnished within three months from the filing of this form
(Form No. 7 Second page)
 (Form No.7 cont’d)

VI. Fees accompany this form

VII. Brief Description of the Design

VIII.Supplemental Box

IX. SIGNATURE: (Applicant/Agent)** (Date)

TO BE FILLED IN BY THE OFFICE

1. Date
* of receipt of corrections, later filed papers completing s the
Application:

2. Date fees received:

 Describe the special main features of the Industrial Design. You can use additional
paper if the space is not sufficient,

 Delete whichever doesn’t apply and type name under signature

(Form No. 7 Third and Last page)