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MM1(E)

MADRID AGREEMENT AND PROTOCOL CONCERNING THE


INTERNATIONAL REGISTRATION OF MARKS
APPLICATION FOR INTERNATIONAL REGISTRATION
GOVERNED EXCLUSIVELY BY THE MADRID AGREEMENT
(Rule 9 of the Common Regulaton!"
IMPORTANT
#$ The %&e!ent MM1 fo&m ! to 'e u!e( )he&e the nte&natonal a%%l*aton ! go+e&ne( exclus!el" #"
$%e M&'(' A)(ee*e+$$ Th! )ll 'e the *a!e,
, )he&e the Office of origin (!ee tem! # an( -" ! the Off*e of a Cont&a*tng State )h*h ! 'oun(
by the Madrid Agreement only. o&
, )he&e the Office of origin ! the Off*e of a Cont&a*tng State )h*h ! 'oun( by both the Madrid
Agreement and the Protocol. an( )he&e all the (e!gnate( Cont&a*tng State! a&e party to the
Agreement but not to the Protocol.
/$ If the nte&natonal a%%l*aton ! go+e&ne( e0*lu!+el1 '1 the Ma(&( P&oto*ol. the fo&m to 'e u!e( !
fo&m MM-$ If t ! go+e&ne( '1 'oth the Ma(&( Ag&eement an( the P&oto*ol. the fo&m to 'e u!e( !
fo&m MM.$
-$ Th! fo&m *us$ #e se+$ $/ $%e O00ce /0 /()+$ It mu!t +/$ 'e !ent (&e*tl1 to the Inte&natonal
2u&eau$
3o&l( Intelle*tual P&o%e&t1 O&gan4aton
-5. *hemn (e! Colom'ette!. P$O$ 2o0 #6.
#/## Gene+a /7. S)t4e&lan(
Tel$, (5#8//" --6 9###
Fa0 (Inte&natonal T&a(ema&9 Reg!t&1", (5#8//" :57 #5/9
e8mal, nt&eg$mal;)%o$nt < Inte&net, http://www.wipo.int
MM# < =anua&1 /779
MM1(E)
APPLICATION FOR INTERNATIONAL REGISTRATION
GOVERNED EXCLUSIVELY BY THE MADRID AGREEMENT
Fo& u!e '1 the a%%l*ant
Th! nte&natonal a%%l*aton n*lu(e! the follo)ng num'e& of,

Fo& u!e '1 the a%%l*ant>Off*e
A%%l*ant?! &efe&en*e,
Off*e?! &efe&en*e,
CONTRACTING STATE 3HOSE OFFICE IS THE OFFICE OF ORIGIN

APPLICANT
(a" Name,

('" A((&e!!,

(*" A((&e!! fo& *o&&e!%on(en*e,

((" Tele%hone, Fa0,
E8mal a((&e!!,
(e" P&efe&&e( language fo& *o&&e!%on(en*e, Engl!h F&en*h S%an!h
ENTITLEMENT TO FILE
(a" Che*9 the a%%&o%&ate 'o0,
(" the a%%l*ant ha! a &eal an( effe*t+e n(u!t&al o& *omme&*al e!ta'l!hment n the te&&to&1 of the Cont&a*tng State
mentone( n tem #@
(" f the&e ! no !u*h e!ta'l!hment n a Cont&a*tng State of the Ag&eement. the a%%l*ant ! (om*le( n the Cont&a*tng
State mentone( n tem #@
(" f the&e ! no !u*h e!ta'l!hment o& (om*le n a Cont&a*tng State of the Ag&eement. the a%%l*ant ! a natonal of the
Cont&a*tng State mentone( n tem #$
('" 3he&e the a((&e!! of the a%%l*ant. g+en n tem /('". ! not n the te&&to&1 of the Cont&a*tng State mentone( n tem #. n(*ate
n the !%a*e %&o+(e( 'elo),
(" f the 'o0 *o&&e!%on(ng to %a&ag&a%h (a"(" of the %&e!ent tem ha! 'een *he*9e(. the a((&e!! of the a%%l*ant?! n(u!t&al o&
*omme&*al e!ta'l!hment n that State. o&
(" f the 'o0 *o&&e!%on(ng to %a&ag&a%h (a"(" of the %&e!ent tem ha! 'een *he*9e(. the (om*le of the a%%l*ant n that State$


APPOINTMENT OF A REPRESENTATIAE (f an1"
Name,
A((&e!!,

Tele%hone, Fa0,
E8mal a((&e!!,
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2ASIC REGISTRATION
2a!* &eg!t&aton num'e&,
Date of the 'a!* &eg!t&aton, (((>mm>1111"
PRIORITB CLAIMED
The a%%l*ant *lam! the %&o&t1 of the ea&le& flng mentone( 'elo),
Off*e of ea&le& flng,
Num'e& of ea&le& flng (f a+ala'le",
Date of ea&le& flng, (((>mm>1111"
If the ea&le& flng (oe! not &elate to all the goo(! an( !e&+*e! l!te( n tem #7 of th! fo&m. n(*ate n the !%a*e %&o+(e( 'elo) the
goo(! an( !e&+*e! to )h*h t (oe! &elate,



If !e+e&al %&o&te! a&e *lame(. *he*9 'o0 an( u!e a *ontnuaton !heet g+ng the a'o+e &eCu&e( nfo&maton fo& ea*h %&o&t1
*lame($
THE MARK
(a" Pla*e the &e%&o(u*ton of the ma&9. a! t a%%ea&! n the
'a!* &eg!t&aton. n the !Cua&e 'elo)$
('" 3he&e the &e%&o(u*ton n tem (a" ! n 'la*9 an( )hte
an( *olo& ! *lame( n tem 6. %la*e a *olo& &e%&o(u*ton
of the ma&9 n the !Cua&e 'elo)$
(*" The a%%l*ant (e*la&e! that he )!he! the ma&9 to 'e *on!(e&e( a! a ma&9 n !tan(a&( *ha&a*te&!$
((" The ma&9 *on!!t! of a *olo& o& a *om'naton of *olo&! a! !u*h$
3he&e the Off*e of o&gn ha! a((&e!!e( th! fo&m '1 fa*!mle. the %&e!ent !%a*e mu!t 'e *om%lete( 'efo&e a((&e!!ng the o&gnal
of th! %age to the Inte&natonal 2u&eau$
Num'e& of 'a!* &eg!t&aton o& Off*e &efe&en*e a! !ho)n on the f&!t %age of th! fo&m,

Sgnatu&e '1 the Off*e of o&gn,
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COLOR(S" CLAIMED
(a" The a%%l*ant *lam! *olo& a! a (!tn*t+e featu&e of the ma&9$
Colo& o& *om'naton of *olo&! *lame(,


('" In(*aton. fo& ea*h *olo&. of the %&n*%al %a&t! of the ma&9 that a&e n that *olo& (a! ma1 'e &eCu&e( '1 *e&tan (e!gnate(
Cont&a*tng State!",



MISCELLANEODS INDICATIONS
(a" T&an!lte&aton of the ma&9 (th! nfo&maton ! *om%ul!o&1 )he&e the ma&9 *on!!t! of o& *ontan! matte& n *ha&a*te&! othe& than
Latn *ha&a*te&!. o& nume&al! othe& than A&a'* o& Roman nume&al!",


('" T&an!laton of the ma&9 (a! ma1 'e &eCu&e( '1 *e&tan (e!gnate( Cont&a*tng State!",
(" nto Engl!h,

(" nto F&en*h,

(" nto S%an!h,

(*" The )o&(! *ontane( n the ma&9 ha+e no meanng (an( the&efo&e *annot 'e t&an!late("$
((" 3he&e a%%l*a'le. *he*9 the &ele+ant 'o0 o& 'o0e! 'elo),
Th&ee8(men!onal ma&9
Soun( ma&9
Colle*t+e ma&9. *e&tf*aton ma&9. o& gua&antee ma&9
(e" De!*&%ton of the ma&9 ()he&e a%%l*a'le",


(f" Ae&'al element! of the ma&9 ()he&e a%%l*a'le",


(g" The a%%l*ant (e*la&e! that he )!he! to (!*lam %&ote*ton fo& the follo)ng element(!" of the ma&9,



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GOODS AND SERAICES
(a" In(*ate 'elo) the goo(! an( !e&+*e! fo& )h*h the nte&natonal &eg!t&aton ! !ought,
Ple&se use 0/+$ 1Courier New2 /( 1T*es Ne3 R/*&+24 s5e 1- 6$4 /( &#/!e
Cla!! Goo(! an( !e&+*e!
('" The a%%l*ant )!he! to l*$ the l!t of goo(! an( !e&+*e! n &e!%e*t of one o& mo&e (e!gnate( Cont&a*tng State!. a! follo)!,
Ple&se use 0/+$ 1Courier New2 /( 1T*es Ne3 R/*&+24 s5e 1- 6$4 /( &#/!e
Cont&a*tng State Cla!!(e!" o& l!t of goo(! an( !e&+*e! fo& )h*h
%&ote*ton ! !ought n th! Cont&a*tng State
If the !%a*e %&o+(e( ! not !uff*ent. *he*9 the 'o0 an( u!e a c/+$+u&$/+ s%ee$
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DESIGNATED CONTRACTING STATES
Che*9 the *o&&e!%on(ng 'o0e!,
AL Al'ana
AM A&mena
AT Au!t&a
A7 A4e&'aFan
BA 2o!na an( He&4ego+na
BG 2ulga&a
BT 2hutan
BX 2enelu0
BY 2ela&u!
CH S)t4e&lan(
CN Chna
CU Cu'a
CY C1%&u!
C7 C4e*h Re%u'l*
DE Ge&man1
D7 Alge&a
EG Eg1%t
ES S%an
FR F&an*e
HR C&oata
HU Hunga&1
IR I&an (I!lam* Re%u'l* of"
IT Ital1
8E Ken1a
8G K1&g14!tan
8P Demo*&at* Peo%le?!
Re%u'l* of Ko&ea
87 Ka4a9h!tan
LI Le*hten!ten
LR L'e&a
LS Le!otho
LV Lat+a
MA Mo&o**o
MC Mona*o
MD Re%u'l* of Mol(o+a
ME Monteneg&o
M8 The fo&me& Bugo!la+
Re%$ of Ma*e(ona
MN Mongola
M7 Mo4am'Cue
NA Nam'a
PL Polan(
PT Po&tugal
RO Romana
RS Se&'a
RU Ru!!an Fe(e&aton
SD Su(an
SI Slo+ena
S8 Slo+a9a
SL Se&&a Leone
SM San Ma&no
SY S1&an A&a' Re%u'l*
S7 S)a4lan(
T9 TaF9!tan
UA D9&ane
VN Aet Nam
Othe&!,
SIGNATDRE 2B THE APPLICANT OR HIS REPRESENTATIAE
(f &eCu&e( o& allo)e( '1 the Off*e of o&gn"
(((>mm>1111"
CERTIFICATION AND SIGNATDRE OF THE INTERNATIONAL APPLICATION 2B THE OFFICE OF ORIGIN
(a" Ce&tf*aton
The Off*e of o&gn *e&tfe!
(" that the &eCue!t to %&e!ent th! a%%l*aton )a! &e*e+e(. o&. a! %&o+(e( n Rule ##(#" of the Regulaton!. ! (eeme( to ha+e 'een
&e*e+e(. on (((>mm>1111"$
(" that the a%%l*ant name( n tem / ! the !ame a! the hol(e& name( n the 'a!* &eg!t&aton mentone( n tem E.
that an1 n(*aton g+en n tem :((". 9((" o& 9(e" a%%ea&! al!o n the 'a!* &eg!t&aton.
that the ma&9 n tem :(a" ! the !ame a! n the 'a!* &eg!t&aton.
that. f *olo& ! *lame( a! a (!tn*t+e featu&e of the ma&9 n the 'a!* &eg!t&aton. the !ame *lam ! n*lu(e( n tem 6 o& that. f
*olo& ! *lame( n tem 6 )thout ha+ng 'eng *lame( n the 'a!* &eg!t&aton. the ma&9 n the 'a!* &eg!t&aton ! n fa*t n the
*olo& o& *om'naton of *olo&! *lame(. an(
that the goo(! an( !e&+*e! l!te( n tem #7 a&e *o+e&e( '1 the l!t of goo(! an( !e&+*e! a%%ea&ng n the 'a!* &eg!t&aton$
3he&e the nte&natonal a%%l*aton ! 'a!e( on t)o o& mo&e 'a!* &eg!t&aton!. the a'o+e (e*la&aton !hall 'e (eeme( to a%%l1 to all
tho!e 'a!* &eg!t&aton!$
('" Off*e?! !gnatu&e,
Date of !gnatu&e, (((>mm>1111"
MM# < =anua&1 /779
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FEE CALCULATION SHEET
(a" INSTRDCTIONS TO DE2IT FROM A CDRRENT ACCODNT
The Inte&natonal 2u&eau ! he&e'1 n!t&u*te( to (e't the &eCu&e( amount of fee! f&om a *u&&ent a**ount o%ene( )th the Inte&natonal
2u&eau (f th! 'o0 ! *he*9e(. t ! not ne*e!!a&1 to *om%lete ('""$
Hol(e& of the a**ount, A**ount num'e&,
I(entt1 of the %a&t1 g+ng the n!t&u*ton!,
('" AMODNT OF FEES (!ee Fee Cal*ulato&, 333:36/:+$;*&'(';e+;0ees;c&lcul&$/(:<s6"
B&sc 0ee, GE- S)!! f&an*! f the &e%&o(u*ton of the ma&9 ! n 'la*9 an( )hte onl1 an(
97- S)!! f&an*! f the&e ! a &e%&o(u*ton n *olo&$ (For international applications filed by applicants
whose country of origin is a Least e!eloped "ountry# in accordance with the list established by the
$nited %ations (333:36/:+$;l'cs;e+;c/u+$(""# &' (wiss francs if the reproduction is in blac) and white
only and *+ (wiss francs if there is a reproduction in color.,
C/*6le*e+$&(" &+' su66le*e+$&(" 0ees,
Num'e& of (e!gnaton! fo&
)h*h *om%lementa&1 fee
! a%%l*a'le
0
Com%lementa&1 fee
#77 S)!! f&an*!
Total amount of the
*om%lementa&1 fee!
H HI
Num'e& of *la!!e! of
goo(! an( !e&+*e! 'e1on(
th&ee
0
Su%%lementa&1 fee
#77 S)!! f&an*!
Total amount of the
!u%%lementa&1 fee!
H HI
GRAND TOTAL (S3ss 0(&+cs)
(*" METHOD OF PABMENT
I(entt1 of the %a&t1 effe*tng the %a1ment,
Pa1ment &e*e+e( an( a*9no)le(ge( '1 3IPO
3IPO &e*e%t num'e&

Pa1ment ma(e to 3IPO 'an9 a**ount
I2AN No$ CHE# 756- E756 :767 6#77 7
C&e(t Su!!e. CH8#/## Gene+a :7
S)ft>2IC, CRESCHJJ67A
Pa1ment (entf*aton

((>mm>1111

Pa1ment ma(e to 3IPO %o!tal a**ount
I2AN No$ CH7- 7977 7777 #/77 E777 6
S)ft>2IC, POFICH2E
Pa1ment (entf*aton

((>mm>1111

MM# < =anua&1 /779
CONTINUATION SHEET No , $$$$$$$$$$ of $$$$$$$$$$
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MM# < =anua&1 /779