I (or we) 1 ............................................................................hereby apply that the Trade mark numbered...................................................................in class ....................be restored to the register and the registration of the said Trade Mark in the class aforesaid be renewed, and that the notice of restoration and renewal be sent to the following address in India.
Dated this ................day of ...........19............
2............SIGNATURE
To
The Registrar of Trade marks,
The office of the Trade Marks Registry at 3.......................