(If the applicant had furnished a label for advertisement, this Form must be accompanied by one unmounted representation of the mark exactly as shown in the Form of application at the time of registration)
I (or we)1......................................................................................request the Registrar to furnish me (us) with 3 duplicate /further copy of the certificate of registration issued to me (us) under sub-section (2) of section 23 in respect of my (our) Trade Mark NO. .............. registered in class ..........in the Register.
The 2 duplicate/further copy of the certificate may be sent to my (our) following address in India:-
............................................................
Dated this ................day of ...........20.......
3...............SIGNATURE
To
The Registrar of Trade marks,
The office of the Trade Marks Registry at 4