MM21(E) MADRID AGREEMENT AND PROTOCOL CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS REQUEST FOR THE CORRECTION OF A RECORDING (Rule 28 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 and Offices of Contracting Parties. 2. Errors made by the International Bureau can be corrected at any time. 3. Errors made by an Office can be corrected only if a request for correction, presented by that Office, is received by the International Bureau within nine months from the date of publication of the recording in the International Register which is the subject of the correction. 4. Errors made by the applicant, holder or representative cannot be corrected. World Intellectual Property Organization 34, chemin des Colombettes 1211 Geneva 20, Switzerland Tel. (Madrid Customer Service): +41 (0)22 338 8686 Fax (Madrid Registry): +41 (0)22 740 1429 e-mail: intreg.mail@wipo.int ­ Internet: www.wipo.int MM21(E) ­ February 2017 American LegalNet, Inc. www.FormsWorkFlow.com MM21(E) REQUEST FOR THE CORRECTION OF A RECORDING For use by the holder This form includes the following number of continuation sheets: For use by the Office This form includes the following number of continuation sheets: Holder's reference: Office's reference: 1 INTERNATIONAL REGISTRATION NUMBER (Please, provide the international registration number (and the letter, if any). Type one digit in each box. For example, for international registration number 123456A, type 123456A) 2 REFERENCE NUMBER (a) If the holder or his/her representative requests the correction: WIPO REFERENCE NUMBER (Please, provide the 9 or 10-digit number that appears in the notification as part of the WIPO reference number. Type one digit in each box. For example, for reference number 806/123456789, type: 123456789) (b) If the Office requests the correction: WIPO NOTIFICATION NUMBER (Please, provide the 3-letter and the 6-digit number that appear in the notification. Type one letter or digit in each box. For example, for reference number ENN/2014/01, type: ENN201401) MM21(E) ­ February 2017 American LegalNet, Inc. www.FormsWorkFlow.com MM21(E), page 2 3 DESCRIPTION OF THE REQUESTED CORRECTION (Please, provide details of the error to be corrected) If the space provided above is not sufficient, check the box and use a continuation sheet. 4 PRESENTATION AND SIGNATURE (a) The request is presented by (please, check the appropriate box): (i) Holder (ii) Representative of the holder (iii) Office By signing this form, I declare that I am entitled to sign it under the applicable law: (b) (c) (d) Name: Signature: E-mail address: American LegalNet, Inc. www.FormsWorkFlow.com MM21(E) ­ February 2017 CONTINUATION SHEET No: .......... of .......... MM21(E) ­ February 2017 American LegalNet, Inc. www.FormsWorkFlow.com