| | | Any class, covered by said registration(s), which is not mentioned below remains as recorded in the International Register. | Any class, covered by said registration(s), which is not mentioned below remains as recorded in the International Register. |
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| (i) | (i) | Entire class(es), if any, to be cancelled (specify only the number(s) of the class(es) concerned), and/or | Entire class(es), if any, to be cancelled (specify only the number(s) of the class(es) concerned), and/or |
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| (ii) | (ii) | If the cancellation affects only some of the goods and services in a given class, provide below the relevant class number and the complete new list of goods and services. This new list will replace the currently recorded list for such class in the International Register (in other words, do not just indicate the goods or services that you wish to delete from the currently recorded list): | If the cancellation affects only some of the goods and services in a given class, provide below the relevant class number and the complete new list of goods and services. This new list will replace the currently recorded list for such class in the International Register (in other words, do not just indicate the goods or services that you wish to delete from the currently recorded list): |
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| | 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. |
| 5. SIGNATURE OF THE HOLDER AND/OR THEIR REPRESENTATIVE
| 5. SIGNATURE OF THE HOLDER AND/OR THEIR REPRESENTATIVE
| 5. SIGNATURE OF THE HOLDER AND/OR THEIR REPRESENTATIVE
| 5. SIGNATURE OF THE HOLDER AND/OR THEIR REPRESENTATIVE
| 5. SIGNATURE OF THE HOLDER AND/OR THEIR REPRESENTATIVE
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| Holder (as recorded in the International Register): | Holder (as recorded in the International Register): | Holder (as recorded in the International Register): | 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:
| 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:
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| Name: | Name: | Name: | Name: |
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| Signature: | Signature: | Signature: | Signature: |
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| Representative of the holder (as recorded in the International Register): | Representative of the holder (as recorded in the International Register): | Representative of the holder (as recorded in the International Register): | 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:
| 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:
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| Name: | Name: | Name: | Name: |
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| Signature: | Signature: | Signature: | Signature: |
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