商标申请书格式APPLICATION FOR INTERNATIONAL REGISTRATION GOVERNED EXCLUSIVELY BY THE MADRID PROTOCOL

MM2(E),page

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MM2(E)–March2016

MM2(E)–March2016

MM2(E)

MADRIDAGREEMENTANDPROTOCOLCONCERNINGTHE

INTERNATIONALREGISTRATIONOFMARKS

APPLICATIONFORINTERNATIONALREGISTRATION

GOVERNEDEXCLUSIVELYBYTHEMADRIDPROTOCOL

(Rule9oftheCommonRegulations)

IMPORTANT

1. ThepresentMM2formistobeusedwheretheinternationalapplicationisgovernedexclusivelybytheMadridProtocol.Thiswillbethecase:

– wheretheOfficeoforigin(seeitems1and3)istheOfficeofaContractingPartywhichisboundbytheMadridProtocolonly,or

– wheretheOfficeoforiginistheOfficeofaContractingPartywhichisboundbyboththeMadridAgreementandtheMadridProtocol,andwhereallthedesignatedContractingPartiesarepartytotheMadridProtocol,irrespectiveofwhetherornottheyarealsopartytotheMadridAgreement.

2. ThisformmustbesenttotheOfficeoforigin.ItmustnotbesentdirectlytotheInternationalBureau.

WorldIntellectualPropertyOrganization

34,chemindesColombettes

1211Geneva20,Switzerland

Tel.(MadridCustomerService):+41(0)223388686

Fax(MadridRegistry):+41(0)227401429

e-mail:

intreg.mail@

–Internet:

MM2(E)

APPLICATIONFORINTERNATIONALREGISTRATION

GOVERNEDEXCLUSIVELYBYTHEMADRIDPROTOCOL

Forusebytheapplicant

Thisinternationalapplicationincludesthefollowingnumberof:

continuationsheets:

MM17forms:

Applicant’sreference:

ForusebytheOffice

Office’sreference:

CONTRACTINGPARTYWHOSEOFFICEISTHEOFFICEOFORIGIN

1

2

APPLICANT

Name:

Address:

Addressforcorrespondence:

Telephone: Fax:

E-mailaddress:

Byprovidingane-mailaddress,anyfurthercorrespondencefromtheInternationalBureaurelatedtothisinternationalapplicationanditsresultinginternationalregistrationwillbesentonlyelectronicallyand,therefore,youwillnolongerreceiveanypapercorrespondence.Likewise,anyfurthercorrespondencefromtheInternationalBureaurelatedtootherinternationalapplicationsorinternationalregistrationsforwhichthesamee-mailaddresshasbeen,orwillbe,providedwillalsobesentonlyelectronically.Please

notethat,forthepurposeofelectroniccommunication,therecanbeonlyonee-mailaddressrecordedpereachinternationalregistration.

Preferredlanguageforcorrespondence:

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English

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French

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Spanish

Otherindications(asmayberequiredbycertaindesignatedContractingParties;forexample,iftheUnitedStatesofAmericaisdesignated,itisnecessarytoincludetheseindications):

iftheapplicantisanaturalperson,nationalityoftheapplicant:

iftheapplicantisalegalentity:

legalnatureofthelegalentity:

Stateand,whereapplicable,territorialunitwithinthatState,underthelawofwhichthelegalentityisorganized:

ENTITLEMENTTOFILE

Checktheappropriatebox:

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wheretheContractingPartymentionedinitem1isaState,theapplicantisanationalofthatState;or

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wheretheContractingPartymentionedinitem1isanorganization,thenameoftheStateofwhichtheapplicantisanational: ;or

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theapplicantisdomiciledintheterritoryoftheContractingPartymentionedinitem1;or

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theapplicanthasarealandeffectiveindustrialorcommercialestablishmentintheterritoryoftheContractingPartymentionedinitem1.

Wheretheaddressoftheapplicant,giveninitem

2(b),isnotintheterritoryoftheContractingPartymentionedinitem

1,indicateinthespaceprovidedbelow:

iftheboxinparagraph

(a)(iii)ofthepresentitemhasbeenchecked,thedomicileoftheapplicantintheterritoryofthatContractingParty,or,

iftheboxinparagraph

(a)(iv)ofthepresentitemhasbeenchecked,theaddressoftheapplicant’sindustrialorcommercialestablishmentintheterritoryofthatContractingParty.

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appointmentofarepresentative

Name:

Address:

Telephone: Fax:

E-mailaddress:4

Byprovidingane-mailaddress,anyfurthercorrespondencefromtheInternationalBureaurelatedtothisinternationalapplicationandits

resultinginternationalregistrationwillbesentonlyelectronicallyand,therefore,youwillnolongerreceiveanypapercorrespondence.Likewise,anyfurthercorrespondencefromtheInternationalBureaurelatedtootherinternationalapplicationsorinternationalregistrationsforwhichthesamee-mailaddresshasbeen,orwillbe,providedwillalsobesentonlyelectronically.Please

notethat,forthepurposeofelectroniccommunication,therecanbeonlyonee-mailaddressrecordedpereachinternationalregistration.

BASICAPPLICATIONORBASICREGISTRATION

Basicapplicationnumber: Dateofthebasicapplication: (dd/mm/yyyy)

Basicregistrationnumber: Dateofthebasicregistration: (dd/mm/yyyy)5

PRIORITYCLAIMED

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Theapplicantclaimsthepriorityoftheearlierfilingmentionedbelow:

Officeofearlierfiling:

Numberofearlierfiling(ifavailable):

Dateofearlierfiling: (dd/mm/yyyy)

Iftheearlierfilingdoesnotrelatetoallthegoodsandserviceslistedinitem

10ofthisform,indicateinthespaceprovidedbelowthegoodsandservicestowhichitdoesrelate:

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Ifseveralprioritiesareclaimed,checktheboxanduseacontinuationsheetgivingtheaboverequiredinformationforeachpriorityclaimed6

.

7

THEMARK

(a) Placethereproductionofthemark,asitappearsinthebasicapplicationorbasicregistration,inthesquarebelow.

(b) Wherethereproductioninitem

(a)isinblackandwhiteandcolorisclaimedinitem

8,placeacolorreproductionofthemarkinthesquarebelow.

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Theapplicantdeclaresthathewishesthemarktobeconsideredasamarkinstandardcharacters.

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Themarkconsistsexclusivelyofacolororacombinationofcolorsassuch,withoutanyfigurativeelement.

WheretheOfficeoforiginhasaddressedthisformbyfacsimile,thepresentspacemustbecompletedbeforeaddressingtheoriginalofthispagetotheInternationalBureau.

NumberofbasicregistrationorOfficereferenceasshownonthefirstpageofthisform:

SignaturebytheOfficeoforigin:

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COLOR(S)CLAIMED

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Theapplicantclaimscolorasadistinctivefeatureofthemark.

Colororcombinationofcolorsclaimed:

Indication,foreachcolor,oftheprincipalpartsofthemarkthatareinthatcolor(asmayberequiredbycertaindesignatedContractingParties):

MISCELLANEOUSINDICATIONS

Transliterationofthemark(thisinformationiscompulsorywherethemarkconsistsoforcontainsmatterincharactersotherthanLatincharacters,ornumeralsotherthanArabicorRomannumerals):

Translationofthemark(asmayberequiredbycertaindesignatedContractingParties):

intoEnglish:

intoFrench:

intoSpanish:

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Thewordscontainedinthemarkhavenomeaning(andthereforecannotbetranslated).

Whereapplicable,checktherelevantboxorboxesbelow:

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Three-dimensionalmark

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Soundmark

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Collectivemark,certificationmark,orguaranteemark

Descriptionofthemark(whereapplicable):

Verbalelementsofthemark(whereapplicable):

Theapplicantdeclaresthathewishestodisclaimprotectionforthefollowingelement(s)ofthemark:

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goodsandservices

Youcanfindindicationsthatarepre-acceptedbytheInternationalBureauintheMadridGoods&ServicesManager(MGS)at

/mgs/

.Byusingtheseindicationsyoucanavoidpossibleirregularitiesconcerningtheclassificationofgoodsandservicesandadelayintherecordingoftheinternationalregistration.

Pleasemakeconsistentuseofasemicolon(;)toclearlyspecifythegoodsandservicesindicationsinyourlist,e.g.:

09Scientific,opticalandelectronicapparatusandinstruments;screensforphotoengraving;computers.

35Advertising;compilationofstatistics;commercialinformationagencies.

Pleaseusefont“CourierNew”or“TimesNewRoman”,size12pt,orabove.

Indicatebelowthegoodsandservicesforwhichtheinternationalregistrationissought:

Class Goodsandservices

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TheapplicantwishestolimitthelistofgoodsandservicesinrespectofoneormoredesignatedContractingParties,asfollows:

ContractingParty Class(es)orlistofgoodsandservicesforwhichprotectionissoughtinthisContractingParty

10

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Ifthespaceprovidedisnotsufficient,checktheboxanduseacontinuationsheet

DESIGNATEDCONTRACTINGPARTIES

(InformationconcerningnationalorregionalproceduresforeachContractingPartydesignatedmaybefoundatthefollowingwebsite:

/madrid/en/members/ipoffices_info.html

.Additionalinformationmaybefoundintheinformationnoticesavailableat:

/madrid/en/notices/

.)

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Checkthecorrespondingboxes:

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AG AntiguaandBarbuda

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AL Albania

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AM Armenia

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AT Austria

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AU Australia

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AZ Azerbaijan

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BA BosniaandHerzegovina

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BG Bulgaria

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BH Bahrain

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BQ Bonaire,SaintEustatiusandSaba6

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BT Bhutan

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BW Botswana

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BX Benelux

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BY Belarus

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CH Switzerland

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CN China

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CO Colombia

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CU Cuba5

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CW Curacao6

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CY Cyprus

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CZ CzechRepublic

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DE Germany

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DK Denmark

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DZ Algeria

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EE Estonia

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EG Egypt

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EM EuropeanUnion1

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ES Spain

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FI Finland

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FR France

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GB UnitedKingdom2

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GE Georgia

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GH Ghana

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GM Gambia

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GR Greece

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HR Croatia

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HU Hungary

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IE Ireland2

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IL Israel

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IN India2

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IR Iran(IslamicRepublicof)

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IS Iceland

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IT Italy

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JP Japan5

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KE Kenya

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KG Kyrgyzstan

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KH Cambodia

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KP DemocraticPeople’s RepublicofKorea

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KR RepublicofKorea

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KZ Kazakhstan

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LA LaoPeople’sDemocraticRepublic

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LI Liechtenstein

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LR Liberia

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LS Lesotho

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LT Lithuania

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LV Latvia

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MA Morocco

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MC Monaco

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MD RepublicofMoldova

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ME Montenegro

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MG Madagascar

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MK TheformerYugoslav

RepublicofMacedonia

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MN Mongolia

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MX Mexico

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MZ Mozambique2

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NA Namibia

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NO Norway

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NZ NewZealand2

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OA AfricanIntellectualPropertyOrganization(OAPI)3

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OM Oman

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PH Philippines

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PL Poland

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PT Portugal

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RO Romania

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RS Serbia

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RU RussianFederation

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RW Rwanda

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SD Sudan

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SE Sweden

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SG Singapore2

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SI Slovenia

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SK Slovakia

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SL SierraLeone

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SM SanMarino

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ST SaoTomeandPrincipe

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SX SintMaarten(Dutchpart)6

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SY SyrianArabRepublic

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SZ Swaziland

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TJ Tajikistan

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TM Turkmenistan

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TN Tunisia

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TR Turkey

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UA Ukraine

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US UnitedStatesofAmerica4

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UZ Uzbekistan

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VN VietNam

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ZM Zambia

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ZW Zimbabwe

Others:

1 ThedesignationoftheEuropeanUnioncoversthefollowingMemberStates:Austria,Belgium,Bulgaria,Croatia,Cyprus,CzechRepublic,Denmark,Estonia,Finland,France,Germany,Greece,Hungary,Ireland,Italy,Latvia,Lithuania,Luxembourg,Malta,TheNetherlands,Poland,Portugal,Romania,Slovakia,Slovenia,Spain,Sweden,UnitedKingdom.

IftheEuropeanUnionisdesignated,itiscompulsorytoindicateasecondlanguagebeforetheOfficeoftheEuropeanUnion,amongthefollowing(checkoneboxonly):

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French

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German

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Italian

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Spanish

Moreover,iftheapplicantwishestoclaimtheseniorityofanearliermarkregisteredin,orfor,aMemberStateoftheEuropeanUnion,theofficialformMM17mustbeannexedtothepresentinternationalapplication.

2 BydesignatingIndia,Ireland,Mozambique,NewZealand,SingaporeortheUnitedKingdom,theapplicantdeclaresthathehastheintentionthatthemarkwillbeusedbyhimorwithhisconsentinthatcountryinconnectionwiththegoodsandservicesidentifiedinthisapplication.

3 ThedesignationoftheAfricanIntellectualPropertyOrganizationcoversthefollowingMemberStates:Benin,BurkinaFaso,Cameroon,CentralAfricanRepublic,Chad,Comoros,Congo,Côted’Ivoire,EquatorialGuinea,Gabon,Guinea,Guinea-Bissau,Mali,Mauritania,Niger,Senegal,Togo.

4 IftheUnitedStatesofAmericaisdesignated,itiscompulsorytoannextothepresentinternationalapplicationtheofficialform(MM18)containingthedeclarationofintentiontousethemarkrequiredbythisContractingParty.Item2(f)ofthepresentformshouldalsobecompleted.

5 CubaandJapanhavemadeanotificationunderRule34(3)(a)oftheCommonRegulations.Theirrespectiveindividualfeesarepayableintwoparts.Therefore,ifCubaorJapanisdesignated,onlythefirstpartoftheapplicableindividualfeeispayableatthetimeoffilingthepresentinternationalapplication.ThesecondpartwillhavetobepaidonlyiftheOfficeoftheContractingPartyconcernedissatisfiedthatthemarkwhichisthesubjectoftheinternationalregistrationqualifiesforprotection.Thedatebywhichthesecondpartmustbepaid,andtheamountdue,willbenotifiedtotheholderoftheinternationalregistrationatalaterstage.

6 TerritorialentitypreviouslypartoftheformerNetherlandsAntilles.

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SIGNATUREBYTHEAPPLICANTAND/ORHISREPRESENTATIVE

(ifrequiredorallowedbytheOfficeoforigin)

CERTIFICATIONANDSIGNATUREOFTHEINTERNATIONALAPPLICATIONBYTHEOFFICEOFORIGIN

Certification

TheOfficeoforigincertifies

thattherequesttopresentthisapplicationwasreceivedon (dd/mm/yyyy).

(ii) thattheapplicantnamedinitem

2isthesameastheapplicantnamedinthebasicapplicationortheholdernamedinthebasicregistrationmentionedinitem

5,asthecasemaybe,

thatanyindicationgiveninitem7(d),9(d)or9(e)appearsalsointhebasicapplicationorthebasicregistration,asthecasemaybe,

thatthemarkinitem

7(a)isthesameasinthebasicapplicationorthebasicregistration,asthecasemaybe,

that,ifcolorisclaimedasadistinctivefeatureofthemarkinthebasicapplicationorthebasicregistration,thesameclaimisincludedinitem

8orthat,ifcolorisclaimedinitem8withouthavingbeingclaimedinthebasicapplicationorbasicregistration,themarkinthebasicapplicationorbasicregistrationisinfactinthecolororcombinationofcolorsclaimed,and

thatthegoodsandserviceslistedinitem

10arecoveredbythelistofgoodsandservicesappearinginthebasicapplicationorbasicregistration,asthecasemaybe.

Wheretheinternationalapplicationisbasedontwoormorebasicapplicationsorbasicregistrations,theabovedeclarationshallbedeemedtoapplytoallthosebasicapplicationsorbasicregistrations.

NameoftheOffice:

(c) NameandsignatureoftheofficialsigningonbehalfoftheOffice:

(d) Nameande-mailaddressofthecontactpersonintheOffice:

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FEECALCULATIONSHEET

INSTRUCTIONSTODEBITFROMACURRENTACCOUNT

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TheInternationalBureauisherebyinstructedtodebittherequiredamountoffeesfromacurrentaccountopenedwiththeInternationalBur