PANDUAN MENGISI BORANG TMA1

BIL KETERANGAN
1. Nature of trademark
Tandakan SATU sahaja.
Jenis Contoh Penerangan
Word mark Tulisan biasa (arial @ times
TUFFAH
new roman)/perkataan
Device mark Gambar/logo sahaja

Combination of Word and Gabungan perkataan &

Device gambar/logo

2. Representation of trademark or graphic representation of the sign

Lampirkan logo/cap dagangan.
(Sila kemukakan logo berwarna sekiranya permohonan terhad kepada warna yang dikehendaki)
3. Description of Trademark
Tidak berkaitan
4. Search and advice are requested in class
Sila rujuk kelas/spesifikasi barangan/perkhidmatan di pautan berikut :
i- https://drive.google.com/file/d/1XM3nwrYTOQZGqqVN4HOpZ19yzQ5qKSb9/view?usp=sharing
ATAU
ii- https://webaccess.wipo.int/mgs/
Contoh :
Class List of Goods or services
30 Coffee, tea, cocoa and artificial coffee; rice, pasta and noodles; tapioca and sago;
bread, pastries and confectionery
BIL KETERANGAN
5. Others

(Sila isi ruangan ini jika cap dagangan selain bahasa Melayu/Inggeris)

NON-NATIONAL LANGUAGE OR ENGLISH

(Bahasa selain Bahasa Melayu/Inggeris)
a Language of the word or Bahasa yang digunakan
words belong: Contoh : Bahasa Arab/Perancis
b Translation of the
trademark into national Terjemahan perkataan ke Bahasa Melayu/Inggeris
language or English:
NON-ROMAN CHARACTER
a Character or script of the Cap dagangan yang mempunyai karakter (bukan rumi).
trademark belong: Contoh : Tamil, Arab, Cina, Jepun dsb.
b Transliteration Penukaran huruf (karakter) kepada huruf yg selaras
bunyinya (tulisan Rumi)
c Translation of the
trademark into national Terjemahan perkataan ke Bahasa Melayu/Inggeris
language or English:
6. Applicant - Pemohon

Full Name: Nama pemohon boleh atas nama individu/syarikat. Jika

atas nama syarikat seperti Enterprise/Resources/
Empire, senaraikan nama pemilik syarikat.

Applicant type (Specify Kategori pemohon. Contoh: Individu/Enterprise/Syarikat

whether Person/individual, /lain-lain
body corporate, partnership,
LLP, association/body
authority or Other)

Company Registration No. No. pendaftaran SSM Enterprise/Syarikat bagi

(For company or businesses permohonan atas nama Enterprise/Syarikat.
registered in Malaysia only)
BIL KETERANGAN

Business Address
• If the address is not within Alamat surat menyurat terkini
Malaysia, you must also
complete section 7 below
• If you want to use address
other than business address,
please also complete section
8

Telephone (For Malaysian No. telefon yang boleh dihubungi

applicant only)

Mode of Correspondence Tidak berkaitan

Applicant’s Reference (If Tidak berkaitan

any)

7. Agent
Tidak berkaitan
8. Address For Services Of The Applicant
Tidak berkaitan
9. Declaration and Signature :
i- Tandakan pada kotak By Person Filing the Form
ii- Signature – tandatangan
iii- Name of Signatory – nama pemohon
iv- Official capacity of signatory – kategori pemohon seperti Owner/Partner
v- Date – tarikh permohonan dibuat
10. Confidentiality Of Document
Tidak berkaitan
11. Scanning Sheet
Tidak berkaitan
12. Payment Details
Tidak berkaitan
 Fee Code
TMA1
INTELLECTUAL PROPERTY CORPORATION OF MALAYSIA
TRADEMARKS ACT 2019
REQUEST FOR PRELIMINARY ADVICE AND SEARCH

Note: Fee for this request is for one class. Please indicate number of classes requested

Nature of trademark ☐ Word mark

1 (Non-traditional Mark, Collective ☐ Device mark
Mark and Certification Mark is not ☒ Combination of Word and Device
applicable) ☐ Shape mark / aspect of packaging,

Please write number of series in this box if the trademark is a series

of trademark

(Note: maximum of 6 series only)

H
Representation of trademark or
2 graphic representation of the sign
TO
If the space provided is insufficient,
the representation may be made on a
separate sheet which must be firmly
annexed to this Form

Note: the size of the

N
representation of the mark shall
be more than 2cm x 2cm and not
more than 10cm x 10cm
O
C

Description of Trademark (Is

3 required if the nature of trademark is
Shape mark or their packaging)
 Search and advice are requested in class: (You may request in more than one class)
4
Class List of Goods or services
30 Coffee, tea, cocoa and artificial coffee; rice, pasta and noodles; tapioca and sago; bread,
pastries and confectionery

OTHERS - Non-Roman character and non-national language or English

5
If the trademark contains and consists of a word and words in non-Roman character or in a language
other than the national language or English, information below must be provided.
Select Particulars
which is

H
applicable
NON-NATIONAL LANGUAGE OR ENGLISH
☒ a Language of the word or BAHASA ARAB
words belong:
TO
b Translation of the
trademark into national
EPAL/APPLE

language or English:
c Please mark off this box if
the word(s) contained in
the trademark have no
N
meaning and cannot be
translated
NON-ROMAN CHARACTER
☐ a Character or script of the
O

trademark belong:
b Transliteration
c Translation of the
C

trademark into national

language or English:
d Please mark off this box if
the word(s) contained in
the trademark have no
meaning and cannot be
translated

APPLICANT [If there is more than one applicant mark off this box and fill additional information]: ☐
6
a Full Name: ALI BIN ABU TRADING AS TUFFAH ENTERPRISE

b Applicant type (Specify ENTERPRISE

whether
 Person/individual, body
corporate, partnership,
LLP, association/body
authority or Other)

c Company Registration 12345-X

No. (For company or
businesses registered in
Malaysia only)

d Business Address
• If the address is not 23, LOT 1 BUSINESS CENTRE 3
within Malaysia, you
must also complete JALAN BERINGIN
section 7 below
• If you want to use Postcode: 43200 Town: AMPANG
address other than
business address, please State/Country: SELANGOR

H
also complete section 8

e Telephone (For Malaysian

applicant only)
TO
03- 2345678
012- 2345678

f Mode of Correspondence ☐ (Mark off this box if you would like us to correspond with
you using our Electronic Filing System services. You must
have a registered ID)
N
g Applicant’s Reference (If DANA IP 2.0
any)
O

AGENT [Fee of RM20 (Fee Code TMR7) will be charged if the agent is newly appointed]
7
C

N/A

ADDRESS FOR SERVICES OF THE APPLICANT (if no agent is appointed and the applicant wanted to
8 have supplementary address other the stated in item 6(d). Fee of RM20.00 (Fee Code TMR7) must be
filed with this application)
N/A
 DECLARATION AND SIGNATURE
9
☒ By Person Filing the Form
I, the undersigned, do hereby declare that the information furnished above is true to the best of my
knowledge.

Signature: ali
Name of signatory: ALI BIN ABU
Official capacity of signatory: OWNER
(Examples: Authorized person, Director, Partner or Principal Officer of Applicant(s)/ Agent)
Date: 06/01/2023

Attention:

H
It is an offence under section 103 of the Trademark Act 2019 to make or cause to be made a false
entry to the Trademark Office and that person may be liable to a fine not exceeding RM50,000 or
a term of imprisonment not exceeding 5 years or to both.
TO
CONFIDENTIALITY OF DOCUMENT
10 (Please tick off the box if applicable)

N/A
N

SCANNING SHEET
11 (Self-calculation for payment of scanning services)
O

No Name of Document No of Page(s) Amount

(RM2 for each page)
C

TOTAL PAGES AND AMOUNT TO PAY

If more space is necessary, Mark off this box and use an additional sheet

PAYMENT DETAILS [Note: This will depend on the method of payment accepted.]
12
☐ Cash ☐ Cheque (Cheque No.
☐ FPX ☐ Local Order LO No.
☐ Credit Card ☐ Other, please specify: