Trademark Application Form | Republic Act No. 8293 1. Applicant Name = uni of Residence or Incorporation Dstt © Natural [Complete Address “Telephone: Name's of other applicants (if any) 2. Resident Agent or Authorized Representative ‘Agent “Address in the Philippines ‘Namo and Position of Company's Authorized Representative If applicant Is not represented by agent) ‘Address inthe Philippines 4. Address for service of correspondence inthe Philippines Please checkone: [| Applicant's address |__| Agontsaddress [| Authorizod Roprsontaivo's addross Telephone: Facsimile: Email: “Tie of Mark {the mark consists of image's or words and imagels, give @ complete and concise description ofthe mark. (Use adaltonel sheets ncessary,)‘The Mark (Tick off those that apply and supply any additional information required.) ‘The marks tree dimensional [7] te marks a tamped or marked container of goods. [| Solots istare claimed as feature of the mark (List down the colors and submit reproduction of mark showing the colors claimed, Fees will be computed based on the number of classies.) [-] The non-English words, aro translated as follows: ‘The non-English charactors «aro transitrated as follows: ‘The applicant does not claim the exclusive right to use the following Claim for convention priority (Priority may be claimed if an application for the same mark for some or all of the goods/services was filed in another convention country in the last six months.) er applicatic ‘Application Number Perm ‘Signature 8. Type of Entity (An applicant claiming to be a smal entity should submit a declaration underoath within sy (60) days from fing. atherse, the applicant wil be assessed to pay the fee required ofa big entity.) [sig rota Assets: tore tan Php s00M) |_| Smal Total Asst: Php 101 or Lass) ‘Additional space, if needed “TMo0}_o109 Page 2012