MM23(E) 226 February 2019 MM23(E) MADRID AGREEMENT AND PROTOCOL CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS REQUEST FOR THE MERGER OF INTERNATIONAL REGISTRATIONS RESULTING FROM THE RECORDING OF A PARTIAL CHANGE IN OWNERSHIP (Rule 27ter(1) of the Common Regulations) IMPORTANT This form must be used to request the merger of international registrations resulting from the recording of a partial change in ownership. This request may be presented directly to the International Bureau by the holder or through the Office of the Contracting Party of the holder. 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 MM23(E) 226 February 2019 MM23(E) REQUEST FOR THE MERGER OF INTERNATIONAL REGISTRATIONS RESULTING FROM THE RECORDING OF A PARTIAL CHANGE IN OWNERSHIP 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; all international registrations to be merged must be in the name of the same person) INTERNATIONAL REGISTRATION NUMBERS (please indicate below the number of all the international registrations to be merged) SIGNATURE BY THE HOLDER OR THE RECORDED REPRESENTATIVE Holder Representative of the holder (as recorded in the International Register) (as recorded in the International Register) 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 OF THE CONTRACTING PARTY OF THE HOLDER PRESENTING THE REQUEST (where this request is presented through that Office) 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: 8 1 3 2 4 American LegalNet, Inc. www.FormsWorkFlow.com