This document contains information for trademark registration in Bangladesh, including the trademark registration number, product or service class, contact information for the applicant or opposing party, and contact information for the appointed trademark agent handling the application or proceedings. It allows for the appointment or revocation of a trademark agent to act on behalf of the applicant, registered owner, or opponent. It also provides for altering an existing service address.

1. 1. Trade Mark Registration Number, if any:
2. Product or Service Class (a single class only):
3. For Inclusion or substitute an address for service in Bangladesh, Applicant,
Registered Proprietor, Registered User, Opponent's:
Full Name: ........................
Address : ........................................
Nationality: ...............
Phone Number:..........................
E-mail ....................
4. Name and address of the trademark agent or lawyer appointed by the
applicant of a trade mark, registered owner, registered user and opponent:
Mr. Md. Shahid Ullah and Mr. Israqul Aman jointly and severally of Messrs.
Shahid & Alliance, Advocates of 30/3 B C Das Street, Lalbagh, Dhaka-1205,
Bangladesh
5. (A) Appointment of Trade Mark Agent or Advocate: I / we appointed my/our behalf
the person mentioned at serial number 4 to apply for registration of the trademark in
the registry or to act in all proceedings.

2. (B) Revocation of Trade Mark Agent or Advocate: I/We hereby revoke previous
authorization in respect of application for registration of a trademark and for all
other proceedings on my/our behalf
6. For alteration of service address:
Existing Address: .................................
Substituted Address : ...............................................
.................................................
Signature of the Trade Mark
Applicant/Registered Owner /
Registered user/Opponent
Dated:
To
The Registrar
Department of Patents, Designs and
..........................................
Signature of the Trade Mark
Agent/Advocate
Dated: