ANNEXURE

( see sub-rule(2) of rule 3)

Format for notice in respect of goods infringing intellectual property rights under Intellectual Property Rights (Imported Goods) Enforcement Rules , 2007

1 Name of the Applicant:

2 Contact Details of the applicant:

(A) Office address:

(B) Residence address

(C) E-mail address

(D) IEC No

3 Applicant's Telephone numbers ( including mobile number)

4 Name and contact details of authorized representative of the right holder. ( please attach authorization from the right holder)

5 Proof of the existence and ownership of a valid intellectual property right by the right holder

6 A statement of the grounds for the notice of suspension of release of the goods allegedly infringing intellectual property rights

7 In the case of a specific consignment of goods allegedly infringing intellectual property rights, details of the consignment and a statement of the ground for the notice including prima facie evidence of infringement

8 Detailed description of the goods with Customs Tariff Heading in respect of which an intellectual property right applies, together with a sample, model or photograph of a genuine product

9. Name of customs airport/ customs port/land customs station to be covered

I/We declare that the particulars furnished above are true to the best of my/our knowledge and the documents enclosed herewith are genuine.

Signature of the right holder or his authorized representative

Office Seal

Place:

Date: