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Request For The Recording Of A Change In Name And-Or Address Of The Holder MM9(E) - Official Federal Forms
| Request For The Recording Of A Change In Name And-Or Address Of The Holder Form. This is a national form and can be used in Madrid System World Intellectual Property Organization . |
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MM9(E) MADRID AGREEMENT AND PROTOCOL CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS REQUEST FOR THE RECORDING OF A CHANGE IN NAME AND/OR ADDRESS OF THE HOLDER (Rule 25 of the Common Regulations) IMPORTANT This form is to be used only to request the recording of a change in the name and/or address and/or correspondence address of the recorded holder. The form to be used for requesting the recording of a change in the ownership of the international registration is form MM5. 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 MM9(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com MM9(E) REQUEST FOR THE RECORDING OF A CHANGE IN NAME AND/OR ADDRESS OF THE HOLDER For use by the holder For use by the holder/Office This request contains the following number of continuation sheets: Holder's reference: Office's reference: 1 INTERNATIONAL REGISTRATION NUMBER(S) (this form may be used for several international registrations of the same holder) 2 NAME OF THE HOLDER (as recorded in the International Register) 3 CHANGE IN NAME AND/OR ADDRESS OF THE HOLDER (indicate the change(s) by ticking the appropriate box(es)) New name: New address: New telephone: New fax: New 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 ADDRESS FOR CORRESPONDENCE (Indicate the address for correspondence, if any, and if different from the address of the holder indicated in item 3; if this item is not completed, the address for correspondence already recorded in the International Register will be automatically disregarded by the International Bureau) Address for correspondence: MM9(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com MM9(E), page 2 5 APPOINTMENT OF A REPRESENTATIVE (optional) (do not complete this item if there is no change in the representative already recorded in the International Register) 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. SIGNATURE OF THE HOLDER APPOINTING THE ABOVE (NEW) REPRESENTATIVE 6 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: 7 OFFICE PRESENTING THE REQUEST (where this request is presented by or through an Office) Name of the Office: Signature and/or stamp of the Office: MM9(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com MM9(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 (The fee is 150 Swiss francs, irrespective of the number of international registrations listed in item 1. No fee is payable, however, where the change concerns only the telephone and/or telefacsimile number) Amount 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 MM9(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com CONTINUATION SHEET No: .......... of .......... MM9(E) January 2013 American LegalNet, Inc. www.FormsWorkFlow.com
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