NBS Intellectual Sdn. Bhd. (972505-M) I-3-3, Block I, Setiawalk, Persiaran Wawasan, Pusat Bandar Puchong 47160 Puchong, Selangor, MALAYSIA T: 603-5891 4846 | F: 603-5879 9908 | E: firstname.lastname@example.org | W: www.nbs.com.my INDUSTRIAL DESIGN DISCLOSURE SHEET 1. APPLICANT (Individual, company, sole proprietor, partnership or association – the intended owner of industrial design) Name Address Email SSM/ROS registration no.(for Malaysian company / sole-proprietor / partnership) I/C no. (for individual) JPPM / ROS registration no. (for Malaysian association) 2. CREATOR (The Designer) Name Address 3. Type of Product / Article(e.g. Food container; Toaster) 4. Date of first disclosure of the Invention in Malaysia (If any) Note for Malaysian Applicant only: If company, send copies of SSM Forms 9 & 49 (and Form 13, if any) by e-mail. If sole-proprietor/partnership, send a copy of SSM Form D by e-mail. If individual, send a copy of I/C by e-mail. If association, send a copy of JPPM / ROS Form 3 by e-mail. Drawing / design of the Product / Article (Please provide perspective, front, back, top, bottom and side views) (Please provide all drawings in a separate sheet or document) Examples of ACCEPTABLE drawings: To be filed in (please tick) ColoursBlack & White Send me a copy of this message NOTE: Please note that a meeting may be required for our consultants to understand the details. Design search / filing will only be conducted after receiving payment and this disclosure sheet.