Australian Designs Act 2003 - Section 21
Design Application
The applicant is entitled to be entered on the Register as the
registered owner of the design(s)
Privacy Notice
The personal information collected on this form is collected for the purposes of the Designs Act 2003 and the Designs
Regulations 2004 (www.ipaustralia.gov.au/about-us/publications/ip-legislation/) and is protected by the Privacy Act
1988 (http://www.comlaw.gov.au/series/c2004a03712).
All personal information you provide on this form is handled in accordance with IP Australia's Privacy Policy (www.
ipaustralia.gov.au/about-us/corporate/privacy-policy/).
The Privacy Policy contains relevant information, including:
how you may seek access to and correction of the personal information we hold;
how you may make a complaint about a breach of the Privacy Act and how we will deal with your complaint;
and
IP Australia's Privacy Contact Officer details.
Any personal information you provide will be used for the purposes of processing this form. IP Australia may also
contact you, using the contact details you have provided, to request your feedback on our products and services.
IP Australia will publish the:
customer name;
customer address;
address for service; and
designer name
in the Official Journal of Designs, the Register of Designs and the Australian Designs Database System (known as
ADDS). Once information is available on the internet, IP Australia has no control over its subsequent use and
disclosure. You should be aware that the information (including personal information) held in IP Australia's online IP
Rights databases is also available on request, subject to our terms and conditions.
In accordance with the Designs Act 2003, IP Australia may disclose relevant personal information collected on this form
to other relevant parties (such as the registered owner of the design or a person registered as having an interest in the
design).
As far as your personal information is concerned:
you may provide a post office box address if you do not want your residential address to be published; and
if you do not provide the personal information required on the form, IP Australia may not be able to process
this form.
IP Australia will not otherwise use or disclose your personal information without your consent, unless authorised or
required by or under law.
D/00/301 (1014) Page 1 of 3
ABN 38 113 072 755
Australian Designs Act 2003 - Section 21
Design Application
The applicant is entitled to be entered on the Register as the
registered owner of the design(s)
Personal Details of Customer
(* denotes mandatory fields)
ACN/ARBN/ABN
*Name
*Address
(can be a
PO Box)
Country (if not Australia)
2nd Name
ACN/ARBN/ABN
(if required)
Address
(can be a
PO Box)
Postcode
State
Postcode
State
Country (if not Australia)
Address for Service of documents in Australia (can be a PO Box)
Address
State
Postcode
State
Postcode
Correspondence Address (if different from the above)
Address
Country (if not Australia)
Agent Details (only complete if you are being represented by an Agent authorised to act on your behalf)
Name
Address
Postcode
State
Optional Details:
Telephone
(
)
Fax
(
)
Email
Address
Mobile
Number
Customer
Number
By completing this form you consent to your personal information being handled in accordance with the Privacy
Notice on page 1 of this form and the IP Australia Privacy Policy.
IP Australia publishes address details in our online databases and bulk data products. Please provide a post
office box if you do not want your residential address to be published.
D/00/301 (1014) Page 2 of 3
ABN 38 113 072 755
Australian Designs Act 2003 - Section 21
Design Application
The applicant is entitled to be entered on the Register as the
registered owner of the design(s)
Please read the instructions provided or contact IP Australia if you have any questions or queries about filling in this form.
Number of Designs
How many designs are in this application:
Note: If this application is for multiple designs, complete Designs
Details section for each design
Reproduce this sheet if there is more than 1 design in the application (use 1 sheet per design).
Design Details
Design Number
Your Design reference
out of total of
Product(s): Indicate the product(s) to which the design relates
Statement of Newness and Distinctiveness (optional)
If you wish to identify particular visual features of the design as new and distinctive please include a statement below (or
attach).
Designer Details
The following person(s) is the designer(s).
Claim for Convention Priority (only if applicable)
Details if claiming priority
Convention Country
Excluded Design (only if applicable)
Filing Date
Basic Application No.
(DD/MM/YYYY)
Important: This application must be made before any of the designs in the initial application are registered or
published.
Initial Design No.:
Request for Registration/Publication
I/We request registration of the design
OR
I/We request publication of the design
Note: This does not give any enforceable design rights.
Important Notes:
If registration is not requested when the design application is filed, a request for registration or
publication must be lodged within 6 months of the design's priority date or the application will lapse.
If the design application is for more than one design and you do not request registration for all the
designs, you may not be able to subsequently request registration of the remaining designs
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ABN 38 113 072 755