MM13(E) 226 June 2019 MM13(E) MADRID AGREEMENT AND PROTOCOL CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS REQUEST FOR THE RECORDING OF A LICENSE (Rule 20bis of the Common Regulations) IMPORTANT 1. This request may be presented to the International Bureau directly by the recorded holder or through the Office of the Contracting Party of the recorded holder or through the Office of a Contracting Party with respect to which the license is granted. 2. One single form may be used to request the recording of a license in respect of several international registrations of the same holder, provided that 226 the licensee is the same for each of the international registrations, and, 226 the license applies to all, or to the same, designated Contracting Parties for each of the international registrations, and, 226 the license concerns all, or the same, goods and services for each of the international registrations. 3. Where the request relates to several international registrations, a fee must be paid in respect of each international registration. 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 MM13(E) 226 June 2019 MM13(E) REQUEST FOR THE RECORDING OF A LICENSE For use by the holder This request contains the following number of continuation sheets: Holder222s reference: For use by the Office Office222s reference: INTERNATIONAL REGISTRATION NUMBER(S) (this form may be used for several international registrations, provided that the licensee is the same and that the license applies to all, or to the same, designated Contracting Parties and concerns all, or the same, goods and services for each of the international registrations) NAME OF THE HOLDER (as recorded in the International Register) LICENSEE (a) Name: (b) Address: (c) Telephone: Fax: E-mail address: By providing an e-mail address, any further correspondence from the International Bureau related to this/these international registration(s) 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 wi ll 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. 1 1 3 1 2 1 1 American LegalNet, Inc. www.FormsWorkFlow.com MM13(E), page 2 MM13(E) 226 June 2019 REPRESENTATIVE OF THE LICENSEE Name: Address: Telephone: ........................................................................ Fax: E-mail address: By providing an e-mail address, any further correspondence from the International Bureau related to this/these international registration(s) 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. SIGNATURE OF THE LICENSEE APPOINTING THE ABOVE REPRESENTATIVE 4 American LegalNet, Inc. www.FormsWorkFlow.com MM13(E), page 3 MM13(E) 226 June 2019 CONTRACTING PARTIES (a) Contracting Parties with respect to which the license is granted (check one box only): The license is to be recorded for all the Contracting Parties designated in the international registration(s) indicated in item 1; The license is to be recorded for some only of the Contracting Parties designated in the international registration(s) indicated in item 1 (specify those designated Contracting Parties, which must be the same for each international registration): (b) Territorial restriction (if applicable): The license concerns only the part indicated below of the territory of the designated Contracting Party(ies) noted below: If the space provided above is not sufficient, check the box and use a continuation sheet NOTE: Australia, Germany and New Zealand have made the declaration provided for by Rule 20bis(6)(a) of the Common Regulations according to which their laws do not provide for the recording of trademark licenses, so that the recording in the International Register of licenses relating to an international registration of a mark has no effect in those countries. Afghanistan, The African Intellectual Property Organization (OAPI), Cambodia, Canada, China, Colombia, Georgia, India, Indonesia, Japan, Kyrgyzstan, Lao People's Democratic Republic, Malawi, Mexico, Republic of Korea, Republic of Moldova, Russian Federation, Samoa, Singapore, The Gambia and Thailand have made the declaration under Rule 20bis(6)(b) of the Common Regulations according to which, while their legislation provides for the recording of licenses, the recording of licenses in the International Register has no effect in their territory. Consequently, the formalities required for the recording of a license relating to an international registration of a mark in those Contracting Parties must be completed directly with their Office, according to the conditions laid down by their respective legislation. 5 American LegalNet, Inc. www.FormsWorkFlow.com MM13(E), page 4 MM13(E) 226 June 2019 GOODS AND SERVICES WITH RESPECT TO WHICH THE LICENSE IS GRANTED (check one box only) The license is to be recorded for all the goods and services covered by the international registration(s) indicated in item 1; The license is to be recorded for the goods and services indicated below in respect of the international registration(s) indicated in item 1 (specify those goods and services, which must be grouped in the appropriate classes and be the same for each international registration): You can find indications that are pre- accepted by the International Bureau in the Madrid Goods & Services Manager (MGS) at www.wipo.int/mgs/ . Please make consistent use of a semicolon (;) to clearly specify the goods and services indications in your list, e.g.: 09 Scientific, optical and electronic apparatus and instruments; screens for photoengraving; computers. 35 Advertising; compilation of statistics; commercial information agencies. Please use font 223Courier New224 or 223Times New Roman224, size 12 pt, or above. If the space provided above is not sufficient, check the box and use a continuation sheet MISCELLANEOUS INDICATIONS (optional) (a) Indications concerning the licensee (as may be required by certain designated Contracting Parties; only provide indications in either item (i) or in item (ii) but not in both items): (i) if the licensee is a natural person, nationality of the licensee: (ii) if the licensee 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: (b) The license is to be recorded as an exclusive license (the license is granted only to one licensee and precludes the holder from using the mark and from granting licenses to any other person); The license is to be recorded as a sole license (the license is granted only to one licensee and precludes the holder from granting licenses to any other person, but does not prevent the holder from using the mark). (c) Duration of the license: SIGNATURE BY THE HOLDER AND/OR HIS REPRESENTATIVE Holder Representative of the holder (as recorded in the Internationa