MM11(E) MADRID AGREEMENT AND PROTOCOL CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS RENEWAL OF THE INTERNATIONAL REGISTRATION (Rule 30 of the Common Regulations) IMPORTANT 1. The use of this form is not compulsory. It is made available for the convenience of holders of international registrations. 2. The international registration may not be renewed in relation to any designated Contracting Party in respect of which a total invalidation or a renunciation has been recorded. However, in the case of partial invalidation, the international registration may be renewed in respect of any designated Contracting Party for those goods and services for which an invalidation has not been recorded. World Intellectual Property Organization 34, chemin des Colombettes, P.O. Box 18, 1211 Geneva 20, Switzerland Tel.: (41-22) 338 9111 Fax (International Trademark Registry): (41-22) 740 1429 e-mail: intreg.mail@wipo.int – Internet: http://www.wipo.int MM11(E) – August 2012 American LegalNet, Inc. www.FormsWorkFlow.com MM11(E) RENEWAL OF THE INTERNATIONAL REGISTRATION For use by the holder/Office For use by the holder This renewal contains the following number of continuation sheets: Holder’s reference: Office’s reference: 1 INTERNATIONAL REGISTRATION NUMBER 2 NAME OF THE HOLDER (as recorded in the International Register) 3 CONTRACTING PARTIES FOR WHICH RENEWAL IS REQUESTED Indicate below the designated Contracting Parties for which the international registration indicated in item 1 is to be renewed (including, where applicable, those Contracting Parties in respect of which a total refusal is recorded in the International Register) AG AL AM AT AU AZ BA BG BH BQ BT BW BX BY CH CN CO CU CW CY CZ DE DK Antigua and Barbuda Albania Armenia Austria Australia Azerbaijan Bosnia and Herzegovina Bulgaria Bahrain Bonaire, Saint Eustatius and Saba* Bhutan Botswana Benelux Belarus Switzerland China Colombia Cuba Curaçao* Cyprus Czech Republic Germany Denmark DZ EE EG EM ES FI FR GB GE GH GR HR HU IE IL IR IS IT JP KE KG KP Algeria Estonia Egypt European Union Spain Finland France United Kingdom Georgia Ghana Greece Croatia Hungary Ireland Israel Iran (Islamic Republic of) Iceland Italy Japan Kenya Kyrgyzstan Democratic People’s Republic of Korea KR KZ LI LR LS LT LV MA MC MD ME MG MK Republic of Korea Kazakhstan Liechtenstein Liberia Lesotho Lithuania Latvia Morocco Monaco Republic of Moldova Montenegro Madagascar The former Yugoslav Rep. of Macedonia MN MZ NA NO OM PH PL PT Mongolia Mozambique Namibia Norway Oman Philippines Poland Portugal Romania Serbia Russian Federation Sudan Sweden Singapore Slovenia Slovakia Sierra Leone San Marino Sao Tome and Principe Sint Maarten* Syrian Arab Republic Swaziland Tajikistan Turkmenistan Turkey Ukraine United States of America UZ Uzbekistan VN Viet Nam ZM Zambia RO RS RU SD SE SG SI SK SL SM ST SX SY SZ TJ TM TR UA US Others: * Territorial entity previously part of the Netherlands Antilles. 4 SIGNATURE Name: Signature: MM11(E) – August 2012 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 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)). Account number: Holder of the account: Identity of the party giving the instructions: (b) AMOUNT OF FEES; METHOD OF PAYMENT Basic fee (653 Swiss francs) Where applicable, surcharge for the grace period (326.50 Swiss Francs) Complementary and supplementary fees: Number of designations for which complementary fee is applicable Total amount of the complementary fees Complementary fee x 100 Swiss francs Number of classes of goods and services beyond three = Total amount of the supplementary fees Supplementary fee x 100 Swiss francs => = => Individual fees (Swiss francs): Designated Contracting Parties Individual fee Designated Contracting Parties Total individual fees Individual fee => 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 made to WIPO postal account IBAN No. CH03 0900 0000 1200 5000 8 Swift/BIC: POFICHBE MM11(E) – August 2012 Payment identification dd/mm/yyyy Payment identification dd/mm/yyyy American LegalNet, Inc. www.FormsWorkFlow.com CONTINUATION SHEET MM11(E) – August 2012 No: .......... of .......... American LegalNet, Inc. www.FormsWorkFlow.com