Form – IV
Nomination of Authorised Indian Representative
(To be issued on company letter head, in original)
1. I, ………………………., CEO/MD/Proprietor/authorised employee (designation…………………….) of
M/s …………………………… (foreign applicant) having its manufacturing unit at ……………………
(complete address), hereby declare that
* a) M/s………………………………… (foreign applicant) have a liaison office / subsidiary firm/
branch office M/s …………………located at ……………..(complete address in India).
OR
* b) M/s…………………………… (foreign applicant) do not have a liaison office /subsidiary
firm/ branch office located in India, but Proprietor/Registered user/subsidiary
firm/liaison office of the Brand/Trademark appearing on the article is located in India by
the name and Title M/s …………………... at …………………(complete address of brand
owner).
OR
* c) M/s…………………………… (foreign applicant) do not have a liaison office / subsidiary
firm/ branch office located in India and there is no Proprietor / Registered
User/subsidiary firm/branch office/ liaison office of the Brand/Trademark appearing on
the article, located in India. Therefore, we nominate the major importer/distributor/
entity having marketing tie-up with the brand owner and /or the manufacturer, as our
authorised Indian representative.
2. Accordingly, M/s …………. , referred above, will act as our authorised representative, and will
sign Affidavit cum undertaking (Form-III A / Form-III B) and other documents relating to
registration.
* Strike off whichever is not applicable.
Yours faithfully,
Details of Authorised Indian Representative: Signature of applicant
M/s …………………. Name:
Address: Designation:
Phone: Address:
E-mail: Phone:
Date: E mail:
Application ID/licence No.: ___________ Date:
Enclosures: As given overleaf
Documents to be submitted in case
I. 1 (a) is applicable
i) Certificate issued by the Registrar of Companies or any other relevant document from
Government/Statutory Authorities which establish proof of its liaison office or branch office in
India
ii) Affidavit cum undertaking (on Rupees One hundred only non-judicial stamp paper, duly
notarised) from the CEO/MD/authorised employee of said liaison office/branch office as per
Form-III A along with the authorisation letter mentioned at 2 of Form-III A.
OR
II. 1 (b) is applicable
i) Document establishing the nominee as the Brand Owner or Proprietor/Registered User/
subsidiary firm/liaison office of the Brand/Trademark in question;
ii) Document authenticating the identity of the nominee (such as Certificate issued by Registrar
of Companies, etc); and
iii) An affidavit cum undertaking (on Rupees One hundred only non-judicial stamp paper, duly
notarised) from the said Brand Owner or Proprietor/ Registered User/ subsidiary firm/liaison
office of the Brand/Trademark located in India or its CEO/MD/authorised employee, as per
Form-III B along with the authorisation letter mentioned at 2 of Form-III B
OR
III. 1 (c) is applicable
i) Document establishing legal status of the entity (Company, Firm, or Proprietorship) as the
such as Certificate issued by Registrar of Companies, Registered Partnership Deed, etc;
ii) Document establishing the entity as the major importer/distributor/ entity having marketing
tie-up with the brand owner and /or the manufacturer.
iii) Declaration from Brand owner that they do not have Proprietor/ Registered User/ subsidiary
firm/liaison office of the Brand/Trademark located in India and that the nominated
representative is the major importer/distributor/ entity having marketing tie-up with the brand
owner.
iv) An affidavit cum undertaking (on Rupees One hundred only non-judicial stamp paper, duly
notarised) by the CEO/MD/authorised employee of the said entity located in India, as per Form-
III B along with the authorisation letter mentioned at 2 of Form-III B.
