MM5

来源机关：国家知识产权局商标局

所属类别：马德里商标国际注册书式 · 来源机关：国家知识产权局商标局 · 文件格式：DOCX

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MM5 (E) – REQUEST FOR THE RECORDING OF A CHANGE IN OWNERSHIP

We strongly recommend that you use eMadrid to request a change in ownership.

For use by the holder (transferor)/new holder (transferee):	For use by the holder (transferor)/new holder (transferee):

Number of continuation sheets for several new holders (transferees):

Number of continuation sheets:

Holder/New holder’s reference:

For use by the Office:	For use by the Office:

Office’s reference:

1. INTERNATIONAL REGISTRATION NUMBER(S) Several international registrations may be indicated below, provided that all registrations concerned are the subject of a total change in ownership, as provided for in item 7(a)).

2. NAME OF THE HOLDER (TRANSFEROR) As recorded in the International Register.

3. E-MAIL ADDRESS OF THE HOLDER (TRANSFEROR) AND/OR THEIR REPRESENTATIVE You must indicate the e-mail address of the holder (transferor) and representative (if applicable) only if these addresses have not already been provided for the international registration(s) indicated in item 1 of this form. If an e-mail address has already been provided, any e-mail address indicated below will be disregarded.	3. E-MAIL ADDRESS OF THE HOLDER (TRANSFEROR) AND/OR THEIR REPRESENTATIVE You must indicate the e-mail address of the holder (transferor) and representative (if applicable) only if these addresses have not already been provided for the international registration(s) indicated in item 1 of this form. If an e-mail address has already been provided, any e-mail address indicated below will be disregarded.	3. E-MAIL ADDRESS OF THE HOLDER (TRANSFEROR) AND/OR THEIR REPRESENTATIVE You must indicate the e-mail address of the holder (transferor) and representative (if applicable) only if these addresses have not already been provided for the international registration(s) indicated in item 1 of this form. If an e-mail address has already been provided, any e-mail address indicated below will be disregarded.

(a)	E-mail address of the holder (transferor):

(b)	E-mail address of the representative:

4. NEW HOLDER (TRANSFEREE) If there is more than one new holder (transferee), indicate the number of new holders (transferees) and complete the “Continuation Sheet for Several New Holders (Transferees)”.	4. NEW HOLDER (TRANSFEREE) If there is more than one new holder (transferee), indicate the number of new holders (transferees) and complete the “Continuation Sheet for Several New Holders (Transferees)”.	4. NEW HOLDER (TRANSFEREE) If there is more than one new holder (transferee), indicate the number of new holders (transferees) and complete the “Continuation Sheet for Several New Holders (Transferees)”.	4. NEW HOLDER (TRANSFEREE) If there is more than one new holder (transferee), indicate the number of new holders (transferees) and complete the “Continuation Sheet for Several New Holders (Transferees)”.	4. NEW HOLDER (TRANSFEREE) If there is more than one new holder (transferee), indicate the number of new holders (transferees) and complete the “Continuation Sheet for Several New Holders (Transferees)”.

Number of new holders (transferees):	Number of new holders (transferees):	Number of new holders (transferees):	Number of new holders (transferees):

(a)	Name:

(b)	Address:	Address:	Address:	Address:






(c)	E-mail address:	E-mail address:

(d)	Telephone number:	Telephone number:

(e)	Nationality or legal nature and State of organization:	Nationality or legal nature and State of organization:	Nationality or legal nature and State of organization:	Nationality or legal nature and State of organization:	Nationality or legal nature and State of organization:	Nationality or legal nature and State of organization:	Nationality or legal nature and State of organization:

	(i)		If the new holder (transferee) is a natural person, indicate the nationality of the new holder (transferee):	If the new holder (transferee) is a natural person, indicate the nationality of the new holder (transferee):	If the new holder (transferee) is a natural person, indicate the nationality of the new holder (transferee):	If the new holder (transferee) is a natural person, indicate the nationality of the new holder (transferee):	If the new holder (transferee) is a natural person, indicate the nationality of the new holder (transferee):
			Nationality of the new holder (transferee):	Nationality of the new holder (transferee):

	(ii)		If the new holder (transferee) is a legal entity, provide both the following indications:	If the new holder (transferee) is a legal entity, provide both the following indications:	If the new holder (transferee) is a legal entity, provide both the following indications:	If the new holder (transferee) is a legal entity, provide both the following indications:	If the new holder (transferee) is a legal entity, provide both the following indications:
			Legal nature of the legal entity:	Legal nature of the legal entity:
			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:	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:

Correspondence details (optional):	Correspondence details (optional):	Correspondence details (optional):	Correspondence details (optional):	Correspondence details (optional):	Correspondence details (optional):	Correspondence details (optional):	Correspondence details (optional):

(f)	Preferred language for correspondence:	Preferred language for correspondence:	Preferred language for correspondence:	English	English	French	Spanish

(g)	Alternative address and e-mail address for correspondence:	Alternative address and e-mail address for correspondence:	Alternative address and e-mail address for correspondence:	Alternative address and e-mail address for correspondence:	Alternative address and e-mail address for correspondence:	Alternative address and e-mail address for correspondence:	Alternative address and e-mail address for correspondence:

	(i)	Postal address:	Postal address:	Postal address:	Postal address:	Postal address:	Postal address:






	(ii)	E-mail address:	E-mail address:

5. ENTITLEMENT OF THE NEW HOLDER (TRANSFEREE) TO BE THE RECORDED HOLDER OF THE INTERNATIONAL REGISTRATION(S)	5. ENTITLEMENT OF THE NEW HOLDER (TRANSFEREE) TO BE THE RECORDED HOLDER OF THE INTERNATIONAL REGISTRATION(S)	5. ENTITLEMENT OF THE NEW HOLDER (TRANSFEREE) TO BE THE RECORDED HOLDER OF THE INTERNATIONAL REGISTRATION(S)
(a)	Indicate in the appropriate spaces:	Indicate in the appropriate spaces:

	(i)	The name of the Contracting State of which the new holder (transferee) is a national; and/or


	(ii)	The name of the State member of a Contracting Organization of which the new holder (transferee) is a national; and/or
		The name of the State member of a Contracting Organization of which the new holder (transferee) is a national; and/or


	(iii)	The name of the Contracting Party in the territory of which the new holder (transferee) is domiciled; and/or


	(iv)	The name of the Contracting Party in the territory of which the new holder (transferee) has a real and effective industrial or commercial establishment.


(b)	Where the new holder (transferee) is not a national of a Contracting State or of a State member of a Contracting Organization and the address given in item 4(b) is not in the territory of any of the Contracting Parties mentioned in paragraph (a)(iii) or (iv) of the present item, indicate in the space provided below:	Where the new holder (transferee) is not a national of a Contracting State or of a State member of a Contracting Organization and the address given in item 4(b) is not in the territory of any of the Contracting Parties mentioned in paragraph (a)(iii) or (iv) of the present item, indicate in the space provided below:

	(i)	The address of the new holder (transferee) in the territory of the Contracting Party mentioned in paragraph (a)(iii) of the present item; or

	(ii)	The address of the new holder’s (transferee) industrial or commercial establishment in the territory of the Contracting Party mentioned in paragraph (a)(iv) of the present item.

6. APPOINTMENT OF A REPRESENTATIVE BY THE NEW HOLDER (TRANSFEREE)	6. APPOINTMENT OF A REPRESENTATIVE BY THE NEW HOLDER (TRANSFEREE)	6. APPOINTMENT OF A REPRESENTATIVE BY THE NEW HOLDER (TRANSFEREE)	6. APPOINTMENT OF A REPRESENTATIVE BY THE NEW HOLDER (TRANSFEREE)	6. APPOINTMENT OF A REPRESENTATIVE BY THE NEW HOLDER (TRANSFEREE)
(a)	Name:	Name:

(b)	Address:	Address:	Address:	Address:






(c)	E-mail address:	E-mail address:	E-mail address:

(d)	Telephone number:	Telephone number:	Telephone number:

SIGNATURE OF THE NEW HOLDER (TRANSFEREE) APPOINTING THE ABOVE REPRESENTATIVE The new holder (transferee) must sign this item in order for the appointment to be recorded.	SIGNATURE OF THE NEW HOLDER (TRANSFEREE) APPOINTING THE ABOVE REPRESENTATIVE The new holder (transferee) must sign this item in order for the appointment to be recorded.	SIGNATURE OF THE NEW HOLDER (TRANSFEREE) APPOINTING THE ABOVE REPRESENTATIVE The new holder (transferee) must sign this item in order for the appointment to be recorded.	SIGNATURE OF THE NEW HOLDER (TRANSFEREE) APPOINTING THE ABOVE REPRESENTATIVE The new holder (transferee) must sign this item in order for the appointment to be recorded.	SIGNATURE OF THE NEW HOLDER (TRANSFEREE) APPOINTING THE ABOVE REPRESENTATIVE The new holder (transferee) must sign this item in order for the appointment to be recorded.
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:	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:	By signing this form, I declare that I am entitled to sign it under the applicable law:
Signature:	Signature:

7. SCOPE OF THE CHANGE IN OWNERSHIP Check either (a) or (b).	7. SCOPE OF THE CHANGE IN OWNERSHIP Check either (a) or (b).	7. SCOPE OF THE CHANGE IN OWNERSHIP Check either (a) or (b).	7. SCOPE OF THE CHANGE IN OWNERSHIP Check either (a) or (b).	7. SCOPE OF THE CHANGE IN OWNERSHIP Check either (a) or (b).	7. SCOPE OF THE CHANGE IN OWNERSHIP Check either (a) or (b).	7. SCOPE OF THE CHANGE IN OWNERSHIP Check either (a) or (b).

(a)				Total change in ownership (the change in ownership is to be recorded for all the Contracting Parties designated in the international registration(s) indicated in item 1, and for all the goods and services covered by such international registration(s)).	Total change in ownership (the change in ownership is to be recorded for all the Contracting Parties designated in the international registration(s) indicated in item 1, and for all the goods and services covered by such international registration(s)).	Total change in ownership (the change in ownership is to be recorded for all the Contracting Parties designated in the international registration(s) indicated in item 1, and for all the goods and services covered by such international registration(s)).

(b)				Partial change in ownership (if this request relates to a partial change in ownership, this form may only be used to request the recording of a change in ownership for a single international registration).	Partial change in ownership (if this request relates to a partial change in ownership, this form may only be used to request the recording of a change in ownership for a single international registration).	Partial change in ownership (if this request relates to a partial change in ownership, this form may only be used to request the recording of a change in ownership for a single international registration).

			(i)	(i)	The change in ownership is to be recorded for the designated Contracting Parties indicated below (if no Contracting Party is indicated, it will be understood that the change in ownership is to be recorded in respect of all the designated Contracting Parties); and/or	The change in ownership is to be recorded for the designated Contracting Parties indicated below (if no Contracting Party is indicated, it will be understood that the change in ownership is to be recorded in respect of all the designated Contracting Parties); and/or
					Designated Contracting Parties:

			(ii)	(ii)	The change in ownership is to be recorded for the goods and services indicated below and grouped in the appropriate classes (if no goods and services are indicated, it will be understood that the change in ownership is to be recorded in respect of all goods and services).	The change in ownership is to be recorded for the goods and services indicated below and grouped in the appropriate classes (if no goods and services are indicated, it will be understood that the change in ownership is to be recorded in respect of all goods and services).








		If the space provided is not sufficient, check the box and use a continuation sheet.	If the space provided is not sufficient, check the box and use a continuation sheet.	If the space provided is not sufficient, check the box and use a continuation sheet.	If the space provided is not sufficient, check the box and use a continuation sheet.	If the space provided is not sufficient, check the box and use a continuation sheet.

8. SIGNATURE OF THE HOLDER (TRANSFEROR) AND/OR THEIR REPRESENTATIVE	8. SIGNATURE OF THE HOLDER (TRANSFEROR) AND/OR THEIR REPRESENTATIVE
Holder (transferor) (as recorded in the International Register):	Holder (transferor) (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 (transferor) (as recorded in the International Register):	Representative of the holder (transferor) (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:

9. SIGNATURE OF THE OFFICE PRESENTING THE REQUEST Where the request is presented through an Office.	9. 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:

METHOD OF PAYMENT If you want to debit the amount of the fees from your Current Account at WIPO, tick the box and provide the information under item (a). If you have already transferred those amounts to WIPO’s bank or postal account, provide as much information as possible under item (b), which would allow WIPO to identify and allocate your payment.	METHOD OF PAYMENT If you want to debit the amount of the fees from your Current Account at WIPO, tick the box and provide the information under item (a). If you have already transferred those amounts to WIPO’s bank or postal account, provide as much information as possible under item (b), which would allow WIPO to identify and allocate your payment.	METHOD OF PAYMENT If you want to debit the amount of the fees from your Current Account at WIPO, tick the box and provide the information under item (a). If you have already transferred those amounts to WIPO’s bank or postal account, provide as much information as possible under item (b), which would allow WIPO to identify and allocate your payment.	METHOD OF PAYMENT If you want to debit the amount of the fees from your Current Account at WIPO, tick the box and provide the information under item (a). If you have already transferred those amounts to WIPO’s bank or postal account, provide as much information as possible under item (b), which would allow WIPO to identify and allocate your payment.	METHOD OF PAYMENT If you want to debit the amount of the fees from your Current Account at WIPO, tick the box and provide the information under item (a). If you have already transferred those amounts to WIPO’s bank or postal account, provide as much information as possible under item (b), which would allow WIPO to identify and allocate your payment.	METHOD OF PAYMENT If you want to debit the amount of the fees from your Current Account at WIPO, tick the box and provide the information under item (a). If you have already transferred those amounts to WIPO’s bank or postal account, provide as much information as possible under item (b), which would allow WIPO to identify and allocate your payment.	METHOD OF PAYMENT If you want to debit the amount of the fees from your Current Account at WIPO, tick the box and provide the information under item (a). If you have already transferred those amounts to WIPO’s bank or postal account, provide as much information as possible under item (b), which would allow WIPO to identify and allocate your payment.
(a)	INSTRUCTIONS TO DEBIT FROM A CURRENT ACCOUNT AT WIPO	INSTRUCTIONS TO DEBIT FROM A CURRENT ACCOUNT AT WIPO	INSTRUCTIONS TO DEBIT FROM A CURRENT ACCOUNT AT WIPO	INSTRUCTIONS TO DEBIT FROM A CURRENT ACCOUNT AT WIPO	INSTRUCTIONS TO DEBIT FROM A CURRENT ACCOUNT AT WIPO	INSTRUCTIONS TO DEBIT FROM A CURRENT ACCOUNT AT WIPO

	The International Bureau is hereby instructed to debit the required amount of fees from a current account opened with WIPO (if this box is checked, it is not necessary to complete (b)).	The International Bureau is hereby instructed to debit the required amount of fees from a current account opened with WIPO (if this box is checked, it is not necessary to complete (b)).	The International Bureau is hereby instructed to debit the required amount of fees from a current account opened with WIPO (if this box is checked, it is not necessary to complete (b)).	The International Bureau is hereby instructed to debit the required amount of fees from a current account opened with WIPO (if this box is checked, it is not necessary to complete (b)).	The International Bureau is hereby instructed to debit the required amount of fees from a current account opened with WIPO (if this box is checked, it is not necessary to complete (b)).	The International Bureau is hereby instructed to debit the required amount of fees from a current account opened with WIPO (if this box is checked, it is not necessary to complete (b)).

Holder of the account:	Holder of the account:
Account number:	Account number:
Identity of the party giving the instructions:	Identity of the party giving the instructions:

(b)	BANK OR POSTAL TRANSFER	BANK OR POSTAL TRANSFER	BANK OR POSTAL TRANSFER	BANK OR POSTAL TRANSFER	BANK OR POSTAL TRANSFER	BANK OR POSTAL TRANSFER

Identity of the party effecting the payment:	Identity of the party effecting the payment:	Identity of the party effecting the payment:

Payment received and acknowledged by WIPO	Payment received and acknowledged by WIPO	Payment received and acknowledged by WIPO	Payment received and acknowledged by WIPO		WIPO receipt number	WIPO receipt number
Payment received and acknowledged by WIPO	Payment received and acknowledged by WIPO	Payment received and acknowledged by WIPO	Payment received and acknowledged by WIPO
Payment made to WIPO bank account Account name: WIPO Bank: UBS SWITZERLAND AG, ZURICH, SWITZERLAND IBAN: CH77 0024 0240 FP10 1035 6 Swift: UBSWCHZH80A	Payment made to WIPO bank account Account name: WIPO Bank: UBS SWITZERLAND AG, ZURICH, SWITZERLAND IBAN: CH77 0024 0240 FP10 1035 6 Swift: UBSWCHZH80A	Payment made to WIPO bank account Account name: WIPO Bank: UBS SWITZERLAND AG, ZURICH, SWITZERLAND IBAN: CH77 0024 0240 FP10 1035 6 Swift: UBSWCHZH80A	Payment made to WIPO bank account Account name: WIPO Bank: UBS SWITZERLAND AG, ZURICH, SWITZERLAND IBAN: CH77 0024 0240 FP10 1035 6 Swift: UBSWCHZH80A		Payment identification	dd/mm/yyyy
Payment made to WIPO bank account Account name: WIPO Bank: UBS SWITZERLAND AG, ZURICH, SWITZERLAND IBAN: CH77 0024 0240 FP10 1035 6 Swift: UBSWCHZH80A	Payment made to WIPO bank account Account name: WIPO Bank: UBS SWITZERLAND AG, ZURICH, SWITZERLAND IBAN: CH77 0024 0240 FP10 1035 6 Swift: UBSWCHZH80A	Payment made to WIPO bank account Account name: WIPO Bank: UBS SWITZERLAND AG, ZURICH, SWITZERLAND IBAN: CH77 0024 0240 FP10 1035 6 Swift: UBSWCHZH80A	Payment made to WIPO bank account Account name: WIPO Bank: UBS SWITZERLAND AG, ZURICH, SWITZERLAND IBAN: CH77 0024 0240 FP10 1035 6 Swift: UBSWCHZH80A
Payment made to WIPO postal account (within Europe only) Account name: WIPO / OMPI SWISS POST/Postfinance, Engelhaldenstrasse 37, CH-3030 Bern IBAN: CH03 0900 0000 1200 5000 8 Swift: POFICHBE	Payment made to WIPO postal account (within Europe only) Account name: WIPO / OMPI SWISS POST/Postfinance, Engelhaldenstrasse 37, CH-3030 Bern IBAN: CH03 0900 0000 1200 5000 8 Swift: POFICHBE	Payment made to WIPO postal account (within Europe only) Account name: WIPO / OMPI SWISS POST/Postfinance, Engelhaldenstrasse 37, CH-3030 Bern IBAN: CH03 0900 0000 1200 5000 8 Swift: POFICHBE	Payment made to WIPO postal account (within Europe only) Account name: WIPO / OMPI SWISS POST/Postfinance, Engelhaldenstrasse 37, CH-3030 Bern IBAN: CH03 0900 0000 1200 5000 8 Swift: POFICHBE		Payment identification	dd/mm/yyyy
Payment made to WIPO postal account (within Europe only) Account name: WIPO / OMPI SWISS POST/Postfinance, Engelhaldenstrasse 37, CH-3030 Bern IBAN: CH03 0900 0000 1200 5000 8 Swift: POFICHBE	Payment made to WIPO postal account (within Europe only) Account name: WIPO / OMPI SWISS POST/Postfinance, Engelhaldenstrasse 37, CH-3030 Bern IBAN: CH03 0900 0000 1200 5000 8 Swift: POFICHBE	Payment made to WIPO postal account (within Europe only) Account name: WIPO / OMPI SWISS POST/Postfinance, Engelhaldenstrasse 37, CH-3030 Bern IBAN: CH03 0900 0000 1200 5000 8 Swift: POFICHBE	Payment made to WIPO postal account (within Europe only) Account name: WIPO / OMPI SWISS POST/Postfinance, Engelhaldenstrasse 37, CH-3030 Bern IBAN: CH03 0900 0000 1200 5000 8 Swift: POFICHBE

FEE CALCULATION SHEET	FEE CALCULATION SHEET	FEE CALCULATION SHEET	FEE CALCULATION SHEET	FEE CALCULATION SHEET	FEE CALCULATION SHEET	FEE CALCULATION SHEET
AMOUNT OF FEES	AMOUNT OF FEES	AMOUNT OF FEES	AMOUNT OF FEES	AMOUNT OF FEES	AMOUNT OF FEES	AMOUNT OF FEES

Amount (177 Swiss francs)	x		(per international registration mentioned in item 1)	GRAND TOTAL (Swiss francs)	=

CONTINUATION SHEET FOR SEVERAL NEW HOLDERS (TRANSFEREES)

No.

Please, complete a separate continuation sheet for each new holder (transferee).

NEW HOLDER (TRANSFEREE)

No.

(a)

Name:

(b)

Address:

(c)

E-mail address:

(d)

Telephone number:

(e)

Nationality or legal nature and State of organization:

(i)

If the new holder (transferee) is a natural person, indicate the nationality of the new holder (transferee):

Nationality of the new holder (transferee):

(ii)

If the new holder (transferee) is a legal entity, provide both the following indications:

Legal nature of the legal entity:

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:

ENTITLEMENT OF THE NEW HOLDER (TRANSFEREE) TO BE THE RECORDED HOLDER OF THE INTERNATIONAL REGISTRATIONS(S)	ENTITLEMENT OF THE NEW HOLDER (TRANSFEREE) TO BE THE RECORDED HOLDER OF THE INTERNATIONAL REGISTRATIONS(S)	ENTITLEMENT OF THE NEW HOLDER (TRANSFEREE) TO BE THE RECORDED HOLDER OF THE INTERNATIONAL REGISTRATIONS(S)
(a)	Indicate in the appropriate spaces:	Indicate in the appropriate spaces:

	(i)	The name of the Contracting State of which the new holder (transferee) is a national; and/or


	(ii)	The name of the State member of a Contracting Organization of which the new holder (transferee) is a national; and/or
		The name of the State member of a Contracting Organization of which the new holder (transferee) is a national; and/or


	(iii)	The name of the Contracting Party in the territory of which the new holder (transferee) is domiciled; and/or


	(iv)	The name of the Contracting Party in the territory of which the new holder (transferee) has a real and effective industrial or commercial establishment.


(b)	Where the new holder (transferee) is not a national of a Contracting State or of a State member of a Contracting Organization and the address given in item 4(b) is not in the territory of any of the Contracting Parties mentioned in paragraph (a)(iii) or (iv) of the present item, indicate in the space provided below:	Where the new holder (transferee) is not a national of a Contracting State or of a State member of a Contracting Organization and the address given in item 4(b) is not in the territory of any of the Contracting Parties mentioned in paragraph (a)(iii) or (iv) of the present item, indicate in the space provided below:

	(i)	The address of the new holder (transferee) in the territory of the Contracting Party mentioned in paragraph (a)(iii) of the present item; or

	(ii)	The address of the new holder’s (transferee) industrial or commercial establishment in the territory of the Contracting Party mentioned in paragraph (a)(iv) of the present item.

CONTINUATION SHEET	No.	of

MM5

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