MM10 (E) – REQUEST FOR THE RECORDING OF A CHANGE IN THE NAME AND/OR ADDRESS OF THE REPRESENTATIVE
We strongly recommend that you use eMadrid to request the recording of a change of name and/or address of the representative.
This form is to be used only to request the recording of a change in the name and/or address of the recorded representative and not to appoint a new representative.
| For use by the representative: | For use by the representative: |
| |
| Number of continuation sheets: | |
| |
| Representative’s reference: | |
| |
| For use by the Office: | For use by the Office: |
| |
| Office’s reference: | |
| 1. INTERNATIONAL REGISTRATION NUMBER(S)
This form may be used for several international registrations of the same representative. |
|
|
|
| 2. NAME OF THE REPRESENTATIVE
As recorded in the International Register. | 2. NAME OF THE REPRESENTATIVE
As recorded in the International Register. | 2. NAME OF THE REPRESENTATIVE
As recorded in the International Register. |
| | |
| (a) | Name: |
|
| | |
| (b) | Address: | Address: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 3. CHANGE IN NAME AND/OR ADDRESS OF THE REPRESENTATIVE | 3. CHANGE IN NAME AND/OR ADDRESS OF THE REPRESENTATIVE | 3. CHANGE IN NAME AND/OR ADDRESS OF THE REPRESENTATIVE | 3. CHANGE IN NAME AND/OR ADDRESS OF THE REPRESENTATIVE |
| | | |
| (a) | New name: |
|
|
| | | |
| (b) | New address: | New address: | New address: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| | | |
| (c) | New e-mail address: | New e-mail address: |
|
| | | |
| (d) | New telephone number: | New telephone number: |
|
| 4. SIGNATURE OF THE HOLDER AND/OR THEIR REPRESENTATIVE
| 4. SIGNATURE OF THE HOLDER AND/OR THEIR REPRESENTATIVE
|
| Holder (as recorded in the International Register): | Holder (as recorded in the International Register): |
| By signing this form, I declare that I am entitled to sign it under the applicable law:
| By signing this form, I declare that I am entitled to sign it under the applicable law:
|
| Name: |
|
| |
| Signature: |
|
| |
| Representative of the holder (as recorded in the International Register): | Representative of the holder (as recorded in the International Register): |
| By signing this form, I declare that I am entitled to sign it under the applicable law:
| By signing this form, I declare that I am entitled to sign it under the applicable law:
|
| Name: |
|
| |
| Signature: |
|
| 5. SIGNATURE OF THE OFFICE PRESENTING THE REQUEST
Where the request is presented through an Office. | 5. SIGNATURE OF THE OFFICE PRESENTING THE REQUEST
Where the request is presented through an Office. |
| |
| (a) | Name of the Office: |
|
|
| |
| (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: |
|
|
| |
| (c) | E-mail address of the contact person in the Office: |
|
|