THE GEOGRAPHICAL INDICATIONS OF GOODS (REGISTRATION & PROTECTION) ACT, 1999

FORM GI-10

A

Application by registered proprietor of a geographical indication for the cancellation of entry thereof in the register or to strike out any goods or classes of goods from those in respect of which the geographical indication is registered

Section 28 (c) or (d)

Fee: Rs. 300 (See entries No. 10-A of the First Schedule)

In the matter of Geographical Indication No.................Class............................................

Name of registered proprietor.......................................................................................

Address as entered in the register.................................................................................

Application is hereby made by the aforesaid registered proprietor that the entry in the Register of Geographical Indication No.....................in class...........................may be cancelled.

A copy of the application has been served on the authorized user(s)

All communications relating to this application may be sent to the following address inIndia:-

Dated this ................. day of

......................20.......

3................................................

Signature

Name of the Signatory (in Block Letters)

B

Form of Authorisation or Agent in a matter or proceeding under the Act

Section 76 and rule 20

I(or We)1..................................hereby authorise2.................................

of....................... to act as my (or our) agent for3.................... and request that all notices, requisitions and communications relating thereto may be sent to such agent at the above address.

I (or We) hereby revoke all previous authorizations, if any, in respect of the proceeding.

All communications relating to this application may be sent to the following address inIndia:-

Dated this ................. day of

......................20.......

4................................................]

Signature

Name of the Signatory (in Block Letters)

For instructions please see overleaf.

To

The Registrar of Geographical Indication

The Office of the Geographical Indications Registry, Chennai.

GI-10A