MM24(E) 226 February 2019 MM24(E) MADRID AGREEMENT AND PROTOCOL CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS REQUEST FOR THE MERGER OF AN INTERNATIONAL REGISTRATION RESULTING FROM THE RECORDING OF DIVISION (Rule 27ter(2)(a) of the Common Regulations) IMPORTANT This form must be used to request the merger of an international registration resulting from the recording of division (divisional international registration) with the international registration from which it was divided (parent international registration). This form must be signed and presented to the International Bureau by the Office of the Contracting Party in respect of which the international registration was divided. 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 MM24(E) 226 February 2019 MM24(E) REQUEST FOR THE MERGER OF AN INTERNATIONAL REGISTRATION RESULTING FROM THE RECORDING OF DIVISION For the holder This request contains the following number of continuation sheets: Holder222s reference: For the Office Office222s reference: NAME OF THE HOLDER (as recorded in the International Register; the international registration resulting from the recording of division (divisional international registration) and the international registration from which it was divided (parent international registration) must both be in the name of the same person) INTERNATIONAL REGISTRATION NUMBER (please indicate below the number of the international registration resulting from the recording of division to be merged with the international registration from which it was divided) SIGNATURE BY THE HOLDER OR THE REPRESENTATIVE (where required or allowed by the Office presenting the request) Holder Representative of the holder (as recorded in the International Register) (before the Office presenting the request) By signing this form, I declare that I am entitled to By signing this form, I declare that I am entitled to sign it under the applicable law: sign it under the applicable law: Name: Name: Signature: Signature: OFFICE PRESENTING THE REQUEST (Office of the Contracting Party in respect of which the international registration was divided) Name of the Office: Name and signature of the official signing on behalf of the Office: By signing this form, I declare that I am entitled to sign it under the applicable law: Name and e-mail address of the contact person in the Office: 4 1 3 2 American LegalNet, Inc. www.FormsWorkFlow.com