MM3(E)

MADRID AGREEMENT AND PROTOCOL CONCERNING THE

INTERNATIONAL REGISTRATION OF MARKS
APPLICATION FOR INTERNATIONAL REGISTRATION
GOVERNED BY BOTH THE MADRID AGREEMENT AND THE MADRID PROTOCOL
(Rule 9 of the Common Regulaton!"
IMPORTANT
#$ The %&e!ent MM3 fo&m ! to 'e u!e( )he&e the nte&natonal a%%l*aton ! go+e&ne( ', both the
Madrd A!ree"e#t a#d the Proto$o%$ Th! )ll 'e the *a!e )he&e the Office of origin (!ee tem! #
an( -" ! the Off*e of a Cont&a*tng Pa&t, )h*h ! 'oun( by both the Madrid Agreement and the
Protocol. an( )he&e the nte&natonal a%%l*aton (e!gnate! at least one Contracting State party to the
Agreement but not to the Protocol an( at least one Contracting Party to the Protocol. &&e!%e*t+e of
)hethe& o& not that Cont&a*tng Pa&t, ! al!o %a&t, to the Ag&eement$
/$ If the nte&natonal a%%l*aton ! go+e&ne( e0*lu!+el, ', the Ma(&( Ag&eement. the fo&m to 'e u!e(
! fo&m MM&$ If t ! go+e&ne( e0*lu!+el, ', the Ma(&( P&oto*ol. the fo&m to 'e u!e( ! fo&m MM'$
-$ Th! fo&m "()t be )e#t to the O**$e o* or!#$ It mu!t #ot 'e !ent (&e*tl, to the Inte&natonal
1u&eau$
2o&l( Intelle*tual P&o%e&t, O&gan3aton
-4. *hemn (e! Colom'ette!. P$O$ 1o0 #5.
#/## Gene+a /6. S)t3e&lan(
Tel$7 (4#8//" --5 9###
Fa0 (Inte&natonal T&a(ema&9 Reg!t&,"7 (4#8//" :46 #4/9
e8mal7 nt&eg$mal;)%o$nt < Inte&net7 http://www.wipo.int
MM-(E" < O*to'e& /6#6
MM3(E)
APPLICATION FOR INTERNATIONAL REGISTRATION
GOVERNED BY BOTH THE MADRID AGREEMENT AND THE MADRID PROTOCOL
Fo& u!e ', the a%%l*ant
Th! nte&natonal a%%l*aton n*lu(e! the follo)ng num'e& of7
*ontnuaton !heet(!"7
MM#: fo&m(!"7
Fo& u!e ', the a%%l*ant=Off*e
A%%l*ant>! &efe&en*e7
Off*e>! &efe&en*e7
CONTRACTING STATE 2HOSE OFFICE IS THE OFFICE OF ORIGIN

APPLICANT
(a" Name7

('" A((&e!!7

(*" A((&e!! fo& *o&&e!%on(en*e7

((" Tele%hone 7 Fa07
E8mal a((&e!!7
(e" P&efe&&e( language fo& *o&&e!%on(en*e7 Engl!h F&en*h S%an!h
(f" Othe& n(*aton! (a! ma, 'e &e?u&e( ', *e&tan (e!gnate( Cont&a*tng Pa&te!@ fo& e0am%le. f the +#ted State) o* A"er$a !
(e!gnate(. t ! ne*e!!a&, to n*lu(e the!e n(*aton!"7
(" f the a%%l*ant ! a natu&al %e&!on. natonalt, of a%%l*ant7
(" f the a%%l*ant ! a legal entt,7
legal natu&e of the legal entt,7
State an(. )he&e a%%l*a'le. te&&to&al unt )thn that State. un(e& the la) of )h*h the legal entt, ! o&gan3e(7

ENTITLEMENT TO FILE
(a" Che*9 the a%%&o%&ate 'o07
(" the a%%l*ant ha! a &eal an( effe*t+e n(u!t&al o& *omme&*al e!ta'l!hment n the Cont&a*tng State mentone( n
tem #@
(" f the&e ! no !u*h e!ta'l!hment n a Cont&a*tng State of the Ag&eement. the a%%l*ant ! (om*le( n the Cont&a*tng
State mentone( n tem #@
(" f the&e ! no !u*h e!ta'l!hment o& (om*le n a Cont&a*tng State of the Ag&eement. the a%%l*ant ! a natonal of the
Cont&a*tng State mentone( n tem #$
('" 2he&e the a((&e!! of the a%%l*ant. g+en n tem /('". ! not n the te&&to&, of the Cont&a*tng State mentone( n tem #. n(*ate
n the !%a*e %&o+(e( 'elo)7
(" f the 'o0 *o&&e!%on(ng to %a&ag&a%h (a"(" of the %&e!ent tem ha! 'een *he*9e(. the a((&e!! of the a%%l*ant>! n(u!t&al o&
*omme&*al e!ta'l!hment n that State. o&.
(" f the 'o0 *o&&e!%on(ng to %a&ag&a%h (a"(" of the %&e!ent tem ha! 'een *he*9e(. the (om*le of the a%%l*ant n that State$



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APPOINTMENT OF A REPRESENTATIAE (f an,"
Name7
A((&e!!7

Tele%hone7 Fa07
E8mal a((&e!!7
1ASIC REGISTRATION
1a!* &eg!t&aton num'e&7
Date of the 'a!* &eg!t&aton7 (((=mm=,,,,"
PRIORITB CLAIMED
The a%%l*ant *lam! the %&o&t, of the ea&le& flng mentone( 'elo)7
Off*e of ea&le& flng7
Num'e& of ea&le& flng (f a+ala'le"7
Date of ea&le& flng7 (((=mm=,,,,"
If the ea&le& flng (oe! not &elate to all the goo(! an( !e&+*e! l!te( n tem #6 of th! fo&m. n(*ate n the !%a*e %&o+(e( 'elo) the
goo(! an( !e&+*e! to )h*h t (oe! &elate7


If !e+e&al %&o&te! a&e *lame(. *he*9 'o0 an( u!e a *ontnuaton !heet g+ng the a'o+e &e?u&e( nfo&maton fo& ea*h %&o&t,
*lame($
THE MARK
(a" Pla*e the &e%&o(u*ton of the ma&9. a! t a%%ea&! n the
'a!* &eg!t&aton. n the !?ua&e 'elo)$
('" 2he&e the &e%&o(u*ton n tem (a" ! n 'la*9 an( )hte
an( *olo& ! *lame( n tem 5. %la*e a *olo& &e%&o(u*ton
of the ma&9 n the !?ua&e 'elo)$
(*" The a%%l*ant (e*la&e! that he )!he! the ma&9 to 'e *on!(e&e( a! a ma&9 n !tan(a&( *ha&a*te&!$
((" The ma&9 *on!!t! of a *olo& o& a *om'naton of *olo&! a! !u*h
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6
5
4
7
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Page -
2he&e the Off*e of o&gn ha! a((&e!!e( th! fo&m ', fa*!mle. the %&e!ent !%a*e mu!t 'e *om%lete( 'efo&e a((&e!!ng the o&gnal of
th! %age to the Inte&natonal 1u&eau$
Num'e& of 'a!* &eg!t&aton o& Off*e &efe&en*e a! !ho)n on the f&!t %age of th! fo&m7

Sgnatu&e ', the Off*e of o&gn7

COLOR(S" CLAIMED
(a" The a%%l*ant *lam! *olo& a! a (!tn*t+e featu&e of the ma&9$
Colo& o& *om'naton of *olo&! *lame(7


('" In(*aton. fo& ea*h *olo&. of the %&n*%al %a&t! of the ma&9 that a&e n that *olo& (a! ma, 'e &e?u&e( ', *e&tan (e!gnate(
Cont&a*tng Pa&te!"7



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MISCELLANEOCS INDICATIONS
(a" T&an!lte&aton of the ma&9 (th! nfo&maton ! *om%ul!o&, )he&e the ma&9 *on!!t! of o& *ontan! matte& n *ha&a*te&! othe& than
Latn *ha&a*te&!. o& nume&al! othe& than A&a'* o& Roman nume&al!"7


('" T&an!laton of the ma&9 (a! ma, 'e &e?u&e( ', *e&tan (e!gnate( Cont&a*tng Pa&te!"7
(" nto Engl!h7

(" nto F&en*h7

(" nto S%an!h7

(*" The )o&(! *ontane( n the ma&9 ha+e no meanng (an( the&efo&e *annot 'e t&an!late("$
((" 2he&e a%%l*a'le. *he*9 the &ele+ant 'o0 o& 'o0e! 'elo)7
Th&ee8(men!onal ma&9
Soun( ma&9
Colle*t+e ma&9. *e&tf*aton ma&9. o& gua&antee ma&9
(e" De!*&%ton of the ma&9 ()he&e a%%l*a'le"7


(f" Ae&'al element! of the ma&9 ()he&e a%%l*a'le"7


(g" The a%%l*ant (e*la&e! that he )!he! to (!*lam %&ote*ton fo& the follo)ng element(!" of the ma&97



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GOODS AND SERAICES
(a" In(*ate 'elo) the goo(! an( !e&+*e! fo& )h*h the nte&natonal &eg!t&aton ! !ought7
P%ea)e ()e *o#t ,Courier New- or ,T"e) Ne. Ro"a#-/ )0e &' 1t/ or abo2e
Cla!! Goo(! an( !e&+*e!
('" The a%%l*ant )!he! to %"t the l!t of goo(! an( !e&+*e! n &e!%e*t of one o& mo&e (e!gnate( Cont&a*tng Pa&te!. a! follo)!7
P%ea)e ()e *o#t ,Courier New- or ,T"e) Ne. Ro"a#-/ )0e &' 1t/ or abo2e
Cont&a*tng Pa&t, Cla!!(e!" o& l!t of goo(! an( !e&+*e! fo& )h*h %&ote*ton !
!ought n th! Cont&a*tng Pa&t,
If the !%a*e %&o+(e( ! not !uff*ent. *he*9 the 'o0 an( u!e a $o#t#(ato# )heet
MM-(E" < O*to'e& /6#6
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DESIGNATED CONTRACTING PARTIES
(Info&maton *on*e&nng natonal o& &egonal %&o*e(u&e! fo& ea*h Cont&a*tng Pa&t, (e!gnate( ma, 'e foun( at the follo)ng )e'!te7
http://www.wipo.int/madrid/en/members/ipoffices_info.html$ A((tonal nfo&maton ma, 'e foun( n the nfo&maton not*e! a+ala'le
at7 http://www.wipo.int/madrid/en/notices/"
Che*9 the *o&&e!%on(ng 'o0e!7
AG Antgua an( 1a&'u(a
AL Al'ana
AM A&mena
AT Au!t&a
A+ Au!t&ala
A3 A3e&'aFan
BA 1o!na an( He&3ego+na
BG 1ulga&a
BH 1ah&an
B4 1ona&e. Sant Eu!tatu!
an( Sa'a
BT 1hutan
B5 1ot!)ana
B6 1enelu0
BY 1ela&u!
CH S)t3e&lan(
CN Chna
C+ Cu'a
4
C5 Cu&aGao
CY C,%&u!
C3 C3e*h Re%u'l*
DE Ge&man,
D7 Denma&9
D3 Alge&a
EE E!tona
EG Eg,%t
EM Eu&o%ean Cnon
#
ES S%an
FI Fnlan(
FR F&an*e
GB Cnte( Kng(om
/
GE Geo&ga
GH Ghana
4
GR G&ee*e
HR C&oata
H+ Hunga&,
IE I&elan(
/
IL I!&ael
IR I&an (I!lam* Re%u'l* of"
IS I*elan(
IT Ital,
8P Ha%an
4
7E Ken,a
7G K,&g,3!tan
7P Demo*&at* Peo%le>!
Re%u'l* of Ko&ea
7R Re%u'l* of Ko&ea
73 Ka3a9h!tan
LI Le*hten!ten
LR L'e&a
LS Le!otho
LT Lthuana
LV Lat+a
MA Mo&o**o
MC Mona*o
MD Re%u'l* of Mol(o+a
ME Monteneg&o
MG Ma(aga!*a&
M7 The fo&me& Bugo!la+
Re%$ of Ma*e(ona
MN Mongola
M3 Mo3am'?ue
NA Nam'a
NO No&)a,
OM Oman
PL Polan(
PT Po&tugal
RO Romana
RS Se&'a
R+ Ru!!an Fe(e&aton
SD Su(an
SE S)e(en
SG Snga%o&e
/
SI Slo+ena
S7 Slo+a9a
SL Se&&a Leone
SM San Ma&no
ST Sao Tome an( P&n*%e
SY S,&an A&a' Re%u'l*
S3 S)a3lan(
T8 TaF9!tan
TM Tu&9men!tan
TR Tu&9e,
+A C9&ane
+S Cnte( State! of
Ame&*a
-
+3 C3'e9!tan
VN Aet Nam
3M Iam'a
Sant Ma&tn
D
Othe&!7

#
If the E(ro1ea# +#o# ! (e!gnate(. t ! *om%ul!o&, to n(*ate a !e*on( language 'efo&e the Off*e of the Eu&o%ean Cnon. among the follo)ng (*he*9 one
'o0 onl,"7 F&en*h Ge&man Italan S%an!h
Mo&eo+e&. f the a%%l*ant )!he! to *lam the !eno&t, of an ea&le& ma&9 &eg!te&e( n. o& fo&. a Mem'e& State of the Eu&o%ean Cnon. the off*al fo&m MM#:
mu!t 'e anne0e( to the %&e!ent nte&natonal a%%l*aton$
/
1, (e!gnatng Ire%a#d. S#!a1ore o& the +#ted 7#!do". the a%%l*ant (e*la&e! that he ha! the ntenton that the ma&9 )ll 'e u!e( ', hm o& )th h!
*on!ent n that *ount&, n *onne*ton )th the goo(! an( !e&+*e! (entfe( n th! a%%l*aton$
-
If the +#ted State) o* A"er$a ! (e!gnate(. t ! *om%ul!o&, to anne0 to the %&e!ent nte&natonal a%%l*aton the off*al fo&m (MM#5" *ontanng the
(e*la&aton of ntenton to u!e the ma&9 &e?u&e( ', th! Cont&a*tng Pa&t,$
4
C(ba/ Gha#a an( 8a1a# ha+e ma(e a notf*aton un(e& Rule -4(-"(a" of the Common Regulaton!$ The& &e!%e*t+e #d2d(a% *ee) are 1a9ab%e # t.o
1art)$ The&efo&e. f C(ba/ Gha#a o& 8a1a# ! (e!gnate(. onl, the f&!t %a&t of the a%%l*a'le n(+(ual fee ! %a,a'le at the tme of flng the %&e!ent
nte&natonal a%%l*aton$ The !e*on( %a&t )ll ha+e to 'e %a( onl, f the Off*e of the Cont&a*tng Pa&t, *on*e&ne( ! !at!fe( that the ma&9 )h*h ! the !u'Fe*t of
the nte&natonal &eg!t&aton ?ualfe! fo& %&ote*ton$ The (ate ', )h*h the !e*on( %a&t mu!t 'e %a(. an( the amount (ue. )ll 'e notfe( to the hol(e& of the
nte&natonal &eg!t&aton at a late& !tage$
D
Te&&to&al entt, %&e+ou!l, %a&t of the fo&me& Nethe&lan(! Antlle!$ ST$- t)o8lette& *o(e not ,et a+ala'le$
SIGNATCRE 1B THE APPLICANT OR HIS REPRESENTATIAE
(f &e?u&e( o& allo)e( ', the Off*e of o&gn"
(((=mm=,,,,"
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CERTIFICATION AND SIGNATCRE OF THE INTERNATIONAL APPLICATION 1B THE OFFICE OF ORIGIN
(a" Ce&tf*aton
The Off*e of o&gn *e&tfe!
(" that the &e?ue!t to %&e!ent th! a%%l*aton )a! &e*e+e(. o&. a! %&o+(e( n Rule ##(#" of the Regulaton!. ! (eeme( to ha+e
'een &e*e+e(. on (((=mm=,,,,"$
(" that the a%%l*ant name( n tem / ! the !ame a! the hol(e& name( n the 'a!* &eg!t&aton mentone( n tem D.
that an, n(*aton g+en n tem :((". 9((" o& 9(e" a%%ea&! al!o n the 'a!* &eg!t&aton.
that the ma&9 n tem :(a" ! the !ame a! n the 'a!* &eg!t&aton.
that. f *olo& ! *lame( a! a (!tn*t+e featu&e of the ma&9 n the 'a!* &eg!t&aton. the !ame *lam ! n*lu(e( n tem 5 o& that.
f *olo& ! *lame( n tem 5 )thout ha+ng 'eng *lame( n the 'a!* &eg!t&aton. the ma&9 n the 'a!* &eg!t&aton ! n fa*t n
the *olo& o& *om'naton of *olo&! *lame(. an(
that the goo(! an( !e&+*e! l!te( n tem #6 a&e *o+e&e( ', the l!t of goo(! an( !e&+*e! a%%ea&ng n the 'a!* &eg!t&aton$
2he&e the nte&natonal a%%l*aton ! 'a!e( on t)o o& mo&e 'a!* &eg!t&aton!. the a'o+e (e*la&aton !hall 'e (eeme( to a%%l, to
all tho!e 'a!* &eg!t&aton!$
('" Off*e>! !gnatu&e7
Date of !gnatu&e7 (((=mm=,,,,"
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Page 5
FEE CALC+LATION SHEET
(a" INSTRCCTIONS TO DE1IT FROM A CCRRENT ACCOCNT
The Inte&natonal 1u&eau ! he&e', n!t&u*te( to (e't the &e?u&e( amount of fee! f&om a *u&&ent a**ount o%ene( )th the Inte&natonal
1u&eau (f th! 'o0 ! *he*9e(. t ! not ne*e!!a&, to *om%lete ('""$
Hol(e& of the a**ount7 A**ount num'e&7
I(entt, of the %a&t, g+ng the n!t&u*ton!7
('" AMOCNT OF FEES (!ee Fee Cal*ulato&7 ...:.1o:#t;"adrd;e#;*ee);$a%$(%ator:<)1"
Ba)$ *ee7 ED- S)!! f&an*! f the &e%&o(u*ton of the ma&9 ! n 'la*9 an( )hte onl, an(
96- S)!! f&an*! f the&e ! a &e%&o(u*ton n *olo&$ (or international applications filed by applicants
whose country of origin is a !east "e#eloped Country$ in accordance with the list established by the
%nited &ations (...:.1o:#t;%d$);e#;$o(#tr9"$ '( Swiss francs if the reproduction is in blac) and white
only and *+ Swiss francs if there is a reproduction in color.,

Co"1%e"e#tar9 a#d )(11%e"e#tar9 *ee)7
Num'e& of (e!gnaton! fo&
)h*h *om%lementa&, fee
! a%%l*a'le
0
Com%lementa&, fee
#66 S)!! f&an*!
Total amount of the
*om%lementa&, fee!
J JK
Num'e& of *la!!e! of
goo(! an( !e&+*e! 'e,on(
th&ee
0
Su%%lementa&, fee
#66 S)!! f&an*!
Total amount of the
!u%%lementa&, fee!
J JK
I#d2d(a% *ee) (S)!! f&an*!"7
De!gnate( Cont&a*tng Pa&te! In(+(ual fee De!gnate( Cont&a*tng Pa&te! In(+(ual fee




















Total n(+(ual fee! JK
GRAND TOTAL (S.)) *ra#$))
(*" METHOD OF PABMENT
I(entt, of the %a&t, effe*tng the %a,ment7
Pa,ment &e*e+e( an( a*9no)le(ge( ', 2IPO
2IPO &e*e%t num'e&

Pa,ment ma(e to 2IPO 'an9 a**ount
I1AN No$ CHD# 645- D645 :656 5#66 6
C&e(t Su!!e. CH8#/## Gene+a :6
S)ft=1IC7 CRESCHII56A
Pa,ment (entf*aton

((=mm=,,,,

Pa,ment ma(e to 2IPO %o!tal a**ount
I1AN No$ CH6- 6966 6666 #/66 D666 5
S)ft=1IC7 POFICH1E
Pa,ment (entf*aton

((=mm=,,,,

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CONTIN+ATION SHEET No 7 $$$$$$$$$$ of $$$$$$$$$$
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