Suspected counterfieing attempt Reporting FORM

To: HoMAI <aimes@vsnl.com>   or   FaxTo:011-689 1603
    Hologram Manufacturers Association of India®

STRICTLY CONFIDENTIAL 

Re: Reporting a Suspected LOOK-ALIKE/ Pass-off OF A GENUINE HOLOGRAM 

[ ] We were approached on:____ ______ ____ by [see ? below] to 
   ( ) design & produce/ ( )replicate  a hologram 
       with following description [see ? below].
   [ ] The sample shown to us is available with us.
   [ ] We suspect it to be an attempt to clandestinely make afresh a 
       ( ) look-alike/ ( ) Pass-off of an existing hologram of:-
           Original Brand Name/ Company:
           __________________________________________________________ 


[ ] I/we have noticed on: ____ ______ ____
    a likely Look-alike/ Pass-off hologram with following description .
    at/with [see ? below].
    On [ ] Product/ [ ] Carton/ [ ] Packaging:-( ) colour photo enclosed
    Product Name: 
    Product Information: 
   
    Product Purchase Cash-Memo/ ReceiptNo:-
            Date: 		Amount Rs 	    [ ]Photocopy attached
[ ] I/we can send the Sample of above suspicious product if reimbursed 
    for the amount spent.
[ ] You may inform the original manufacturer/ copyright holder, 
    who may have registered the hologram (with above description).
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DESCRIPTION OF THE LIKELY LOOK=ALIKE/ PASS-OFF HOLOGRAM:-
Image TEXT(exact): If not in English, please write in Roman Script, 
            and mention <Language & exact equivalent words in English>
 Fore-ground: 
 Mid-ground:  
 Back-ground: 

Image DESIGN: [describe (if possible) the image in your own keywords]
 Fore-ground: 
 Mid-ground:  
 Back-ground: 
 
Image GRAPHICS: Put [x] in appropriate box(es) below:-
 F    M    B  [F]oreground/ [M]idground/ [B]ackground
[ ]  [ ]  [ ] Micro Lettering
[ ]  [ ]  [ ] Repeating Pattern 
[ ]  [ ]  [ ] Repeating Text
[ ]  [ ]  [ ] Logo/ Trademark

CONTACT INFORMATION OF THE Person/Establisment
[ ] trying to place order for Hologram for  [ ] producing/ [ ] selling/ supplying 
    products having a likely Look-alike or a Pass-off Hologram:-
Name, designation:
 Organisation:
 Address:
 City - PinCode, St(ate):
 Phone:
 Fax:
 Email:

ADDITIONAL INFORMATION (if any):
---------------------------------------------

STRICTLY CONFIDENTIAL <will not be disclosed> 
Person reporting the above: 
 Name, designation:
 Organisation:
 Address:
 City - PinCode, St(ate):
 Phone:
 Fax:
 Email: