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APPLICATION FOR REGISTRATION OF
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| APPLICANT - Name and address | |
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Client Number (If already assigned by ICT) |
| Postal code | |
| TITLE(S) |
| DESCRIPTION OF THE NATURE OR FUNCTION OF TOPOGRAPHY |
| INTEREST |
| __ Creator of topography OR __ Successor in title |
| CONDITIONS OF REGISTRATION |
| Registrability in Canada is dependent upon the following conditions: The creator of the topography is, at the time of its creation or on the filing date of the application: i) a national of Canada; ii) a national of a country recognized by Canada by convention or treaty that affords protection for topographies; iii) a national of a country that the Minister has certified by notice published in the Canada Gazette; OR The creator of the topography has, at the time of its creation or on the filing, a real and effective establishment for the creation of topographies or the manufacture of integrated circuit products in Canada or a country that is a member of the World Trade Organization (WTO) or has a reciprocal agreement with Canada; OR The topography is first commercially exploited in Canada and the application is filed within two years thereafter. |
| COMMERCIAL EXPLOITATION |
| __ The topography has not been commercially exploited OR __ The topography was first commercially exploited in _______________ on _________________ (place/ country) (day/ month/ year) |
| MATERIAL FILED AND OTHER INFORMATION |
| AGENT - Name and address | |
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Client Number (If already assigned by ICT) |
| Postal code | |
| REPRESENTATIVE FOR SERVICE - Name and address in Canada | |
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Client Number (If already assigned by ICT) |
| Postal code | |
| SIGNATURE(S) | |
| ______________________________ Contact person (please print or type) ______________________________ Signature(s) |
(check appropriate box) __ applicant __ agent |
| Telephone no. | |