Form MM11 (Madrid Agreement Concerning the International by NIQe3C

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									                                                                                                                         MM11(E)

                                  MADRID AGREEMENT AND PROTOCOL CONCERNING THE

                                           INTERNATIONAL REGISTRATION OF MARKS




                                    RENEWAL OF THE INTERNATIONAL REGISTRATION

                                                   (Rule 30 of the Common Regulations)




                                                              IMPORTANT

                    1.   The use of this form is not compulsory. It is made available for the convenience of holders of
                         international registrations.

                    2.   The international registration may not be renewed in relation to any designated Contracting Party in
                         respect of which a total invalidation or a renunciation has been recorded. However, in the case of
                         partial invalidation, the international registration may be renewed in respect of any designated
                         Contracting Party for those goods and services for which an invalidation has not been recorded.




                                                 World Intellectual Property Organization
                                                34, chemin des Colombettes, P.O. Box 18,
                                                      1211 Geneva 20, Switzerland
                                                         Tel.: (41-22) 338 9111
                                       Fax (International Trademark Registry): (41-22) 740 1429
                                      e-mail: intreg.mail@wipo.int – Internet: http://www.wipo.int


MM11(E) – January 2011
                                                                                                                                      MM11(E)
                                    RENEWAL OF THE INTERNATIONAL REGISTRATION

                                For use by the holder                                                        For use by the holder/Office

    This renewal contains the following number of continuation sheets:                 Holder’s reference:

                                                                                       Office’s reference:


    1        INTERNATIONAL REGISTRATION NUMBER




    2        NAME OF THE HOLDER
             (as recorded in the International Register)




    3        CONTRACTING PARTIES FOR WHICH RENEWAL IS REQUESTED

             Indicate below the designated Contracting Parties for which the international registration indicated in item 1 is to be renewed
             (including, where applicable, those Contracting Parties in respect of which a total refusal is recorded in the International Register)

        AG   Antigua and Barbuda                   DZ     Algeria                          KR   Republic of Korea               RO Romania
        AL   Albania                               EE     Estonia                          KZ   Kazakhstan                      RS Serbia
        AM   Armenia                               EG     Egypt                            LI   Liechtenstein                   RU Russian Federation
        AT   Austria                               EM     European Union                   LR   Liberia                         SD Sudan
        AU   Australia                             ES     Spain                            LS   Lesotho                         SE Sweden
        AZ   Azerbaijan                            FI     Finland                          LT   Lithuania                       SG Singapore
        BA   Bosnia and Herzegovina                FR     France                           LV   Latvia                          SI Slovenia
        BG   Bulgaria                              GB     United Kingdom                   MA   Morocco                         SK Slovakia
        BH   Bahrain                               GE     Georgia                          MC   Monaco                          SL Sierra Leone
        BQ   Bonaire, Saint Eustatius              GH     Ghana                            MD   Republic of Moldova             SM San Marino
             and Saba*                             GR     Greece                           ME   Montenegro                      ST Sao Tome and Principe
        BT   Bhutan                                HR     Croatia                          MG   Madagascar                      SX Sint Maarten*
        BW   Botswana                              HU     Hungary                          MK   The former Yugoslav             SY Syrian Arab Republic
        BX   Benelux                               IE     Ireland                               Rep. of Macedonia               SZ Swaziland
        BY   Belarus                               IL     Israel                           MN   Mongolia                        TJ Tajikistan
        CH   Switzerland                           IR     Iran (Islamic Republic of)       MZ   Mozambique                      TM Turkmenistan
        CN   China                                 IS     Iceland                          NA   Namibia                         TR Turkey
        CU   Cuba                                  IT     Italy                            NO   Norway                          UA Ukraine
        CW   Curaçao*                              JP     Japan                            OM   Oman                            US United States of
        CY   Cyprus                                KE     Kenya                            PL   Poland                             America
        CZ   Czech Republic                        KG     Kyrgyzstan                       PT   Portugal                        UZ Uzbekistan
        DE   Germany                               KP     Democratic People’s                                                   VN Viet Nam
        DK   Denmark                                      Republic of Korea                                                     ZM Zambia


Others:


*
     Territorial entity previously part of the Netherlands Antilles.


    4        SIGNATURE

             Name:


             Signature:




MM11(E) – January 2011
                                                                                                                                            Page 2

                                                               FEE CALCULATION SHEET


 (a)   INSTRUCTIONS TO DEBIT FROM A CURRENT ACCOUNT

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

 Holder of the account:                                                                             Account number:

 Identity of the party giving the instructions:


 (b)   AMOUNT OF FEES; METHOD OF PAYMENT

 Basic fee (653 Swiss francs)

 Where applicable, surcharge for the grace period (326.50 Swiss Francs)

 Complementary and supplementary fees:

 Number of designations for
 which complementary fee                                                              Total amount of the
 is applicable                                Complementary fee                       complementary fees
                                   x              100 Swiss francs              =                                     =>

 Number of classes of
 goods and services beyond                                                            Total amount of the
 three                                          Supplementary fee                     supplementary fees
                                   x              100 Swiss francs              =                                     =>

 Individual fees (Swiss francs):
   Designated Contracting Parties         Individual fee                             Designated Contracting Parties        Individual fee




                                                                                              Total individual fees   =>

                                                                          GRAND TOTAL (Swiss francs)

 Identity of the party effecting the payment:
                                                                     WIPO receipt number

 Payment received and acknowledged by WIPO

 Payment made to WIPO bank account
 IBAN No. CH51 0483 5048 7080 8100 0                                 Payment identification                                dd/mm/yyyy

 Credit Suisse, CH-1211 Geneva 70
 Swift/BIC: CRESCHZZ80A

 Payment made to WIPO postal account
 IBAN No. CH03 0900 0000 1200 5000 8                                 Payment identification                                dd/mm/yyyy

 Swift/BIC: POFICHBE




MM11(E) – January 2011
                         CONTINUATION SHEET   No: .......... of ..........




MM11(E) – January 2011

								
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