ID FORM 13 INTELLECTUAL PROPERTY CORPORATION OF MALAYSIA Industrial Designs Act 1996 Industrial Designs Regulations 1999 (Section 43 and Regulation 43) Industrial Designs Registration Office REQUEST FOR EXTENSION OF TIME 1. Application number (For official use only): 2. Full name and address of the / each applicant: 3. Name of agent (if applicable): Address for service in Malaysia to which correspondence should be sent: 4. How long an extension do you want? State 1, 2 or 3 months. 5. Completion date: (State the completion date of the act or thing in respect of which the extension of time is requested, regard to the extension of time in column 4) 6. Declaration: I / We request for an extension of time to the date stated in column 5. (Delete whichever is not applicable) Signature(s) 7. Date Name and telephone number of person to contact in Malaysia: