MM12 (E) – APPOINTMENT OF A REPRESENTATIVE
We strongly recommend that you use eMadrid to appoint a representative.
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| For use by the Office: |
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| 1. NAME OF THE APPLICANT AND/OR HOLDERAs indicated in the international application(s) and/or as recorded in the International Register. |
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| 2. E-MAIL ADDRESS OF THE APPLICANT AND/OR HOLDERYou must indicate the e-mail address of the applicant/holder only if this address has not already been provided for the international application(s)/registration(s) indicated in item 3 of this form. If an e-mail address has already been provided, any e-mail address indicated below will be disregarded. |
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| E-mail address of the applicant/holder: | |
| 3. INTERNATIONAL APPLICATION(S) REFERENCE(S) AND/OR INTERNATIONAL REGISTRATION NUMBER(S)This form may be used for several international applications and/or registrations in the name of the same applicant and/or holder. For international applications, indicate the basic mark(s), basic application/registration number(s) and date(s) and the filing date of the international application(s). For international registrations, indicate the international registrations concerned by the appointment of the representative: |
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| 4. REPRESENTATIVE |
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| (a) | Name: | |
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| (b) | Address: |
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| (c) | E-mail address: | |
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| (d) | Telephone number: | |
| 5. SIGNATURE OF THE APPLICANT AND/OR HOLDERAs indicated in the international application(s) and/or as recorded in the International Register. |
| By signing this form, I declare that I am entitled to sign it under the applicable law: |
| Name: | |
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| Signature: | |
| 6. SIGNATURE OF THE OFFICE PRESENTING THE REQUESTWhere the request is presented through an Office. |
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| (a) | Name of the Office: |
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| (b) | 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: |
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| (c) | E-mail address of the contact person in the Office: |
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本表为图形化/图片式官方表单，在线可提取文字较少，请下载原件查看完整表格样式后打印填写。
