Request to Executive Director of the EUIPO for exemption pursuant to

Article 120(4) of the European Union trade mark Regulation (EUTMR) and
Article 78(6) of the Community design Regulation (CDR)

Section 1 Applicant data (grey fields obligatory)

First name(s):

Surname(s):

Nationality:

Street and
number

Post code
Business address:
Town

Country

Business telephone:

Business fax:

Business email address:

Street and
number

Post code

Correspondence address (if

different to Business address): Town

Country

Telephone

Association name (if

applicable):

Central industrial property

office before which the
applicant is entitled to
represent:

Avenida de Europa, 4 • 03008 Alicante • Spain

Tel. +34 965139100 • www.euipo.europa.eu
Type of request (please tick one):

Exemption from the 5 years professional experience requirement (Article 120(4)(a)

EUTMR and Article 78(6)(b) CDR);
Exemption from the EEA nationality requirement (Article 120(4)(b) EUTMR and
Article 78(6)(a) CDR).

Section 2 Application and declaration of fulfilment of conditions

I hereby apply for an exemption to the Executive Director of the EUIPO pursuant to
Article 120(4) EUTMR and Article 78(6) CDR.

i) Exemption from the 5 years professional experience requirement:

I fulfil the following conditions:

I am a national of a Member State of the EEA;

I have my place of business or employment in the EEA;

I am entitled to represent natural or legal persons in trade mark or design matters

before a central industrial property office of the EEA. Although I have not regularly
acted as a representative for at least five years before the relevant central industrial
property office, I have acquired this requisite qualification in another way.

ii) Exemption from the EEA nationality requirement:

I fulfil the following conditions:

I have my place of business or employment in the EEA;

I am entitled to represent natural or legal persons in trade mark or design matters

before a central industrial property office of the EEA;

I am a ‘highly qualified professional’.

In support of my request for exemption, I am enclosing evidence to prove: i) the acquisition of my

experience equivalent to at least 5 years acting as a representative before the central industrial
property office concerned, or ii) that I am a ‘highly qualified professional’.

The following evidence is enclosed (please tick as appropriate):

(a) professional experience ‘acting as a representative’ in trade mark and/or

design matters in the EEA Member State concerned (1);
(b) professional experience ‘acting as a representative’ in IP-related areas of law
other than trade mark or design matters in the EEA Member State concerned;

1
( ) The experience is acquired in the same EEA Member State where the requestor is entitled to represent others in
trade mark or design matters.

Avenida de Europa, 4 • 03008 Alicante • Spain

Tel. +34 965139100 • www.euipo.europa.eu
 (c) professional experience performed under my own responsibility and authority;

(d) professional experience performed under supervision, assisted by others, as part

of a team, etc;
(e) professional experience that exceeds 5 years duration;
(f) professional experience that is attributable to a specific trade mark and/or design
portfolio (e.g. IP rights filed and managed);
(g) formal qualifications;
(h) publications, research or articles in recognised peer reviewed journals or
specialised publications, book authorship, experience in IP educational field, etc.

Section 3 Signature

Date:

Signature:

Name:

Information concerning annexes:

The evidence submitted in support of the request must fulfil the requirements of Article 55
EUTMDR (applicable by analogy). Therefore, it must:

 be contained in an annex to the submission;

 be numbered;
 be accompanied by an index with a short description of each item, together with the
number of pages (if applicable) and the page number where it is mentioned in the
submission;
 clearly identify the category of evidence to which it applies (a), (b), (c), etc.

Avenida de Europa, 4 • 03008 Alicante • Spain

Tel. +34 965139100 • www.euipo.europa.eu