Clothing Line Intellectual Property Claim Form

Claimant Information

Full Name Company Name (if applicable) Email Address Phone Number

Intellectual Property Details

Type of Intellectual Property Trademark Copyright Patent Design Other Title/Description of IP Registration Number (if applicable) Details / Description

Complaint Details

Alleged Infringing Party Description of Alleged Infringement List of Infringing Items / URLs

Supporting Evidence

Description of Attached Evidence

Declaration

I declare that the information provided is accurate and complete. Electronic Signature Date