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1、MM12(E)MADRID AGREEMENT AND PROTOCOL CONCERNING THEINTERNATIONAL REGISTRATION OF MARKSAPPOINTMENT OF A REPRESENTATIVEIMPORTANT1. The use of this form is not compulsory. It is made available for the convenience of holders of international registrations.2. This form may relate to one or more internati
2、onal registrations of the same holder.World Intellectual Property Organization34, chemin des Colombettes, P.O. Box 18,1211 Geneva 20, SwitzerlandTel.: (41-22) 338 9111Fax (International Trademark Registry): (41-22) 740 1429e-mail: intreg.mailwipo.int Internet: http:/www.wipo.intMM12(E)APPOINTMENT OF
3、 A REPRESENTATIVEFor use by the applicant/holderThis request contains the following number of continuation sheets:For use by the holder/OfficeHolders reference: Offices reference: NAME OF THE HOLDER(as recorded in the International Register)INTERNATIONAL REGISTRATION NUMBER(S)(this form may be used
4、for several international registrations of the same holder)Indicate below the international registration number(s) concerned by the appointment of the representative:1213REPRESENTATIVE3Name: Address: Telephone: Fax: E-mail address: 4 HOLDER(as recorded in the International Register)Name:Signature: OFFICE PRESENTING THE REQUEST(where applicable)5Name of the OfficeSignature and/or stamp of the OfficeCONTINUATION SHEETNo: . of .