DECLARATION OF ACTUAL USE

(This Declaration of Actual Use required to be made pursuant to Sec. 124.2 and Sec 145 of R.A 8293,
otherwise the application shall be refused or the mark shall be removed from the Register.)
Please check one:

[x] Within three (3) years from filing

[ ] Within one year from the fifth (5th) anniversary of the registration of the mark
Registration No.:
Date issued:
[ ] Registered under Republic Act No. 166
[ ] Tenth (10th) anniversary
Registration No.: __________________ Date issued: __________________
[ ] Fifteenth (15th) anniversary
Registration No.:
Date issued:

_______________________________________________________________________________________
I, JANET TAN, of legal age, Filipino citizen, under oath, depose and state:
1. I am the

[ ] applicant for registration

[ ] authorized officer of applicant-corporation
[ ] registered owner
[x] authorized officer of registered owner-corporation

of AMERICAN DELITE hereinafter referred to as the Mark;

2. The Mark

[ ] was accorded filing date on

[x] was issued Registration No. 4-2008-007645
for the following classes of goods and/or services:
Class 31 Rice Grains

3. The Mark was first used on ____________.

4. The Mark is actually and presently used in the Philippines for the following goods and/or services;
Rice Grains
5. The goods are sold and /or services are rendered in the following outlets:
Name of Outlet / Address

6. As proof of actual use, attached are five (5) labels or pictures of the Mark;
7. This affidavit is executed to attest to the truth of the foregoing and for the purpose of complying with
the requirements of R.A. 8293 and the Trademark Regulations.

JANET TAN
Affiant
SUBCRIBED AND SWORN TO before me this ________________________, affiant exhibiting to
me her TIN 109-030-851-000.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2011.