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Request For Amendment For The Recording Of A License MM14(E) - Official Federal Forms
| Request For Amendment For The Recording Of A License Form. This is a national form and can be used in Madrid System World Intellectual Property Organization . |
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MM14(E) MADRID AGREEMENT AND PROTOCOL CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS REQUEST FOR AMENDMENT OF THE RECORDING OF A LICENSE (Rule 20bis of the Common Regulations) IMPORTANT 1. This form is to be used only to request the amendment of the recording of a license. Where it is intended to request the cancellation of a license, form MM15 must be submitted. 2. This request may be presented to the International Bureau directly by the holder or by the Office of the Contracting Party of the holder or by the Office of a Contracting Party with respect to which the license is granted. 3. One single form may be used to request the amendment of the recording of a license in respect of several international registrations of the same holder, provided that the amendment applies to all, or to the same, designated Contracting Parties, for each of the international registrations concerned; and the amendment concerns all, or the same, goods and services, for each of the international registrations concerned. 4. Where the request relates to several international registrations, a fee must be paid in respect of each international registration. 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 MM14(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com MM14(E) REQUEST FOR AMENDMENT FOR THE RECORDING OF A LICENSE For use by the holder For use by the holder/Office This request contains the following number of continuation sheet: Holder's reference: Office's reference: 1 INTERNATIONAL REGISTRATION NUMBER(S) (this form may be used for several international registrations of the same holder where, for each registration, the amendment concerns all, or the same, goods and services and applies to all, or the same, designated Contracting Parties) 2 NAME OF THE HOLDER (as recorded in the International Register) 3 LICENSEE (as recorded in the International Register) Name: Address: 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 CHANGE(S) (where there are several licenses recorded in respect of the international registrations(s), it should be clearly indicated which license(s) the amendment concerns) Tick the appropriate box(es): (a) New name of the licensee: (b) New address of the licensee: (c) Details of other change(s): MM14(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com MM14(E), page 2 5 SIGNATURE BY THE HOLDER OR HIS REPRESENTATIVE Holder (as recorded in the International Register) Representative of the holder (as recorded in the International Register) Name: Name: Signature: Signature: 6 OFFICE PRESENTING THE REQUEST (where applicable) Name of the Office: Signature and/or stamp of the Office: MM14(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com MM14(E), page 3 FEE CALCULATION SHEET (a) INSTRUCTIONS TO DEBIT FROM A CURRENT ACCOUNT The International Bureau is hereby instructed to debit the required amount of fees from a current account opened with the International Bureau (if this box is checked, it is not necessary to complete (b)). Holder of the account: Account number: Identity of the party giving the instructions: (b) AMOUNT OF FEES; METHOD OF PAYMENT Amount (177 Swiss francs) × (per international registration mentioned in item 1) Grand total (Swiss francs) Identity of the party effecting the payment: WIPO receipt number Payment received and acknowledged by WIPO Payment made to WIPO bank account IBAN No. CH51 0483 5048 7080 8100 0 Credit Suisse, CH-1211 Geneva 70 Swift/BIC: CRESCHZZ80A Payment identification dd/mm/yyyy Payment made to WIPO postal account IBAN No. CH03 0900 0000 1200 5000 8 Swift/BIC: POFICHBE Payment identification dd/mm/yyyy MM14(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com CONTINUATION SHEET No: .......... of .......... MM14(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com
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