FORMULIR PERMOHONAN PENDAFTARAN MEREK INDONESIA

APPLICATION FORM OF TRADEMARK REGISTRATION OF INDONESIA

Data Permohonan (Application)

Nomor e-Filing : WFT2019101117 Tanggal : 2019-07-04
Number of e-Filing Permohonan
Date of Submission
Nomor Permohonan : D252019035133 Jenis Permohonan : Merek Dagang Non
Number of Application Type of Application UMKM

Rincian Merek (Description of Mark)

Nama Merek : Daeng_Bebycumi By dr.Ali Badar Etiket Gambar
Name of Mark Image of Mark
Arti : memiliki gambar bayi cumi sebagai bahan
Meaning dasar pembuatan makanan, warna latar pink,
tulisan ungu dengan desain logo bundar
Warna : Ungu, Pink, Putih
Colors
Diclaimer : kata dan warna
Disclaimer

Pemohon (Applicant)

Nama (Name) Alamat (Address) Surel/Telp. (Email/Phone)

Desa Wantulasi, Kecamatan Wakorumba alibadarmuhammad@gmail.com
dr. Muhamad Ali Badar
Utara , Buton Utara, 93745, Indonesia 085333320438

Kelas Barang/Jasa (Classs of Goods / Services)

Kode
Jenis Barang/Jasa (Description of Goods/Services)
(Class)
30 Saos Cabe dan Makanan;

Data Prioritas (Priority Data)

Negara (Country) Nomor (Number) Tanggal (Date)

Kuasa/Konsultan KI (Representative/IP Consultant)

Nama (Name) Alamat (Address) Surel/Telp. (Email/Phone)

Lampiran (Attachments)
Fotokopi KTP
Surat Pernyataan Kepemilikan

Jakarta, 2019-07-04
Pemohon / Kuasa
Applicant / Representative

Tanda tangan / Signature

Nama lengkap / Full Name Kanwil Sulawesi Tenggara
Signature Not
Verified
Digitally signed
by eFiling DJKI
Date: 2019.07.05 Halaman 1
16:11:17 ICT
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