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Appointment Of A Representative MM12(E) - Official Federal Forms
| Appointment Of A Representative Form. This is a national form and can be used in Madrid System World Intellectual Property Organization . |
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MM12(E) MADRID AGREEMENT AND PROTOCOL CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS APPOINTMENT OF A REPRESENTATIVE IMPORTANT 1. The use of this form is not compulsory. It is made available for the convenience of holders of international registrations. 2. This form may relate to one or more international registrations of the same holder. World Intellectual Property Organization 34, chemin des Colombettes 1211 Geneva 20, Switzerland Tel. (Switchboard): +41 (0)22 338 9111 Fax (Madrid Registry): +41 (0)22 740 1429 e-mail: intreg.mail@wipo.int Internet: http://www.wipo.int MM12(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com MM12(E) APPOINTMENT OF A REPRESENTATIVE For use by the applicant/holder For use by the holder/Office This request contains the following number of continuation sheets: Holder's reference: Office's reference: 1 NAME OF THE HOLDER (as recorded in the International Register) 2 1 INTERNATIONAL REGISTRATION NUMBER(S) (this form may be used for several international registrations of the same holder) Indicate below the international registration number(s) concerned by the appointment of the representative: 3 REPRESENTATIVE Name: Address: Telephone: Fax: E-mail address: Please check this box if you wish to receive electronic communication. By checking this box: (i) any further correspondence from the International Bureau related to this international application and its resulting international registration will be sent only electronically; likewise, (ii) any further correspondence from the International Bureau related to other international applications or international registrations for which the same e-mail address has been provided will be sent only electronically. Please note that, for the purpose of electronic communication, there can be only one e-mail address recorded per each international application. 4 HOLDER (as recorded in the International Register) Name: Signature: 5 OFFICE PRESENTING THE REQUEST (where applicable) Name of the Office Signature and/or stamp of the Office MM12(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com CONTINUATION SHEET No: .......... of .......... MM12(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com
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