MM2(E) 226 June 2019 MM2(E) MADRID AGREEMENT AND PROTOCOL CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS APPLICATION FOR INTERNATIONAL REGISTRATION GOVERNED EXCLUSIVELY BY THE MADRID PROTOCOL (Rule 9 of the Common Regulations) IMPORTANT 1. This form must be used to file an international application under the Madrid Protocol. 2. This form must be sent to the Office of origin. It must not be sent directly to the International Bureau. This cover page must not be sent to the International Bureau. Madrid System 226 Contacts Madrid Customer Service opening hours: Monday 226 Friday, 9:00 a.m. to 6:00 p.m. (Geneva time) Telephone: + 41 22 338 86 86 Inquiries / submitting forms: http://www.wipo.int/madrid/en/contact/ Mailing address Madrid Operations Division Madrid Registry Brands and Designs Sector World Intellectual Property Organization (WIPO) 34, Chemin des Colombettes 1211 Geneva 20 Switzerland American LegalNet, Inc. www.FormsWorkFlow.com MM2(E) 226 June 2019 MM2(E) APPLICATION FOR INTERNATIONAL REGISTRATION GOVERNED EXCLUSIVELY BY THE MADRID PROTOCOL For use by the applicant This international application includes the following number of: 226 continuation sheets: 226 MM17 forms: Applicant222s reference: For use by the Office Office222s reference: CONTRACTING PARTY WHOSE OFFICE IS THE OFFICE OF ORIGIN APPLICANT (a) Name: (b) Address: (c) Address for correspondence: (d) Telephone : Fax: E-mail address: By providing an e-mail address, any further correspondence from the International Bureau related to this international application and its resulting international registration will be sent only electronically and, therefore, you will no longer receive any paper correspondence. Likewise, any further correspondence from the International Bureau related to other international applications or international registrations for which the same e-mail address has been, or will be, provided will also 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 registration. (e) Preferred language for correspondence: English French Spanish (f) Other indications (as may be required by certain designated Contracting Parties, such as, for example, the United States of America; only provide indications in either item (i) or in item (ii) but not in both items): (i) if the applicant is a natural person, nationality of the applicant: (ii) if the applicant is a legal entity (please, provide both the following indications): 226 legal nature of the legal entity: 226 State (country) and, where applicable, territorial unit within that State (canton, province, state, etc.), under the law of which the said legal entity has been organized: 1 2 American LegalNet, Inc. www.FormsWorkFlow.com MM2(E), page 2 MM2(E) 226 June 2019 ENTITLEMENT TO FILE (a) Check the appropriate box: (i) where the Contracting Party mentioned in item 1 is a State, the applicant is a national of that State; or (ii) where the Contracting Party mentioned in item 1 is an organization, the name of the State of which the applicant is a national: ; or (iii) the applicant is domiciled in the territory of the Contracting Party mentioned in item 1; or (iv) the applicant has a real and effective industrial or commercial establishment in the territory of the Contracting Party mentioned in item 1. (b) Where the address of the applicant, given in item 2(b), is not in the territory of the Contracting Party mentioned in item 1, indicate in the space provided below: (i) if the box in paragraph (a)(iii) of the present item has been checked, the domicile of the applicant in the territory of that Contracting Party, or, (ii) if the box in paragraph (a)(iv) of the present item has been checked, the address of the applicant222s industrial or commercial establishment in the territory of that Contracting Party. APPOINTMENT OF A REPRESENTATIVE Name: Address: Telephone: Fax: E-mail address: By providing an e- mail address, any further correspondence from the International Bureau related to this international application and its resulting international registration will be sent only electronically and, therefore, you will no longer receive any paper correspondence. Likewise, any further correspondence from the International Bureau related to other international applications or international registrations for which the same e-mail address has been, or will be, provided will also 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 registration. BASIC APPLICATION OR BASIC REGISTRATION Basic application number: Date of the basic application: dd/mm/yyyy) Basic registration number: Date of the basic registration: (dd/mm/yyyy) 3 5 4 American LegalNet, Inc. www.FormsWorkFlow.com MM2(E), page 3 MM2(E) 226 June 2019 PRIORITY CLAIMED The applicant claims the priority of the earlier filing mentioned below: Office of earlier filing: Number of earlier filing (if available): Date of earlier filing: (dd/mm/yyyy) If the earlier filing does not relate to all the goods and services listed in item 10 of this form, indicate in the space provided below the goods and services to which it does relate: If several priorities are claimed, check the box and use a continuation sheet giving the above required information for each priority claimed. THE MARK (a) Place the reproduction of the mark, as it appears in the basic application or basic registration, in the square below. (b) Where the reproduction in item (a) is in black and white and color is claimed in item 8, place a color reproduction of the mark in the square below. (c) The applicant declares that he wishes the mark to be considered as a mark in standard characters. (d) The mark consists exclusively of a color or a combination of colors as such , without any figurative element . COLOR(S) CLAIMED (a) The applicant claims color as a distinctive feature of the mark. Color or combination of colors claimed: (b) Indication, for each color, of the principal parts of the mark that are in that color (as may be required by certain designated Contracting Parties): 6 7 8 American LegalNet, Inc. www.FormsWorkFlow.com MM2(E), page 4 MM2(E) 226 June 2019 MISCELLANEOUS INDICATIONS (a) Transliteration of the mark (this information is compulsory where the mark consists of or contains matter in characters other than Latin characters, or numerals other than Arabic or Roman numerals): (b) Translation of the mark (as may be required by certain designated Contracting Parties; do not check the box in item (c) if you provide a translation in this item): (i) into English: (ii) into French: (iii) into Spanish: (c) The words contained in the mark have no meaning (and therefore cannot be translated; do not check this box if you have provided a translation in item (b)). (d) Where applicable, check the relevant box or boxes below: Three-dimensional mark Sound mark Collective mark, certification mark, or guarantee mark (e) Description of the mark (as may be required by certain designated Contracting Parties, such as, for example, the United States of America) (i) Description of the mark contained in the basic application or basic registration, where applicable (only use this item if the Office of origin requires you to include this description in the international application for the purposes of item 13(a)(ii) of this form) (ii) Voluntary description of the mark (any description of the mark by words, including the description contained in the basic application or registration, if you were not required to provide this description in item (e)(i) above): (f) Verbal elements of the mark (where applicable): (g) The applicant wishes to disclaim protection for the following element(s) of the mark: 9 American LegalNet, Inc. www.FormsWorkFlow.com MM2(E), page 5 MM2(E) 226 June 2019 GOODS AND SERVICES You can find indications that are pre-accepted by the International Bureau in the Madrid Goods & Services Manager (MGS) at www.wipo.int/mgs/ . By using these indications you can avoid possible irregularities concern ing the cl