(To be filed in triplicate accompanied by a statement in triplicate of the grounds for the application).
Application is hereby made by 1 ........................................ being (the registered proprietor)2 a (registered user) of trade mark(s) No.3.........................registered in class ................in respect of 4....................for the cancellation of the entry under the abovementioned registration(s) of5 ...................as a registered user of the trade mark(s) in respect of6..............
The grounds for this application are set forth in the accompanying statement
All communications relating to this application may be sent to the following address in India:-
Dated this ................day of ...........20............
7............SIGNATURE
To
The Registrar of Trade marks,
The office of the Trade Marks Registry at 8.......................