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PROTOCOL RELATING TO THE MADRID AGREEMENT

CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS

APPLICATION FOR INTERNATIONAL REGISTRATION

GOVERNED EXCLUSIVELY BY THE MADRID PROTOCOL

(Rule 9 of the Common Regulations)

[그림생략]

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

APPLICATION FOR INTERNATIONAL REGISTRATION GOVERNED EXCLUSIVELY BY THE MADRID PROTOCOL
For use by the applicant This request contains the follow- ing number of continuation sheets :		For use by the applicant/Office Applicant`s reference : Office's reference :
[1] CONTRACTING PARTY WHOSE OFFICE IS THE OFFICE OF ORIGIN:
[2] APPLICANT (a) Name: (b) Address: (c) Address for correspondence: (d) Telephone : Fax: E-mail address : (e) Preferred language for correspondence: □ English □ French (f) Other indications(as may be required by certain designated Contracting Parties) ; (ⅰ) if the applicant is a natural person, nationality of applicant : (ⅱ) if the applicant is a legal entity : - legal nature of the legal entity : - State and, where applicable, territorial unit within that State, under the law of which the legal entity is organized :
[3] ENTITLEMENT TO FILE (a) Check the appropriate box(es) : (ⅰ) □ where the Contracting Party mentioned in item 1 is a State, that the applicant is a national of that State; or (ⅱ) □ where the Contracting Party mentioned in item 1 is an organization, the name of the State of which the applicant is a national; ; or (ⅲ) □ the applicant is domiciled in the territory of the

Contracting Party mentioned in item 1; or

(ⅳ) □ the applicant has a real and effective industrial or

commercial establishment in the territory of the Contracting

Party mentioned in item 1.

(b) Where the address of the applicant, given in item 2(b), is not in

the territory of the Contracting Party mentioned in item 1,

indicate in the space provided below :

(ⅰ) if the box paragraph (a)(ⅲ) of the present item has been

checked, the domicile of the applicant in the territory of

that Contracting Party, or,

(ⅱ) if the box paragraph (a)(ⅳ) of the present item has been

checked, the address of the applicants industrial or

commercial establishment in the territory of that Contracting

Party

[4] REPRESENTATIVE(if any)

Name:

Address:

Telephone :               Fax:

E-mail address :

[5] BASIC APPLICATION OR BASIC REGISTRATION

Basic application number :        Date of the basic application :

(dd/mm/yyyy)

Basic registration number :        Date of the basic registration:

(dd/mm/yyyy)

[6] PRIORITY CLAIMED

□ The applicant claims the priority of the earlier filing mentioned

below.

Office of priority filing :

Number of earlier filing (if available) :

Date of earlier filing :                                  (dd/mm/yyyy)

If the earlier filing does not relate to all the goods and services listed in item 10 of this form, indicate in the space provided below the goods and services for which it does relate : □ If serveral priorities are claimed, check box and use a continuati- on sheet giving the above required information for each prioity claimed.
[7] THE MARK
(a) Place the reproduction of the mark, as it appears in the basic application or the basic registration, in the square below.			(b) Where the reproduction in item (a) is in black and white and color is claimed in item 8 place a color reproduction of the mark in the square below.
(c) □ The applicant declares that he wishes the mark to be considered as a mark in standard characters. (d) □ The mark consists of color or a combination of colors as such.
	Where the Office of origin has addressed this form by telefacsi- mile, the present space must be completed before addressing the original of this page to the International Bureau. Number of basic application or registration or Office reference as shown on the first page of this form : Signature by the Office of origin :
[8] COLOR(S) CLAIMED (a) □ The applicant claims color as a distinctive feature of the mark.

Color or combination of colors claimed:

(b) Indication, for each color, of the principal parts of the mark

that are in that color(as may be required by certain designated

ContractingParties) :

[9] MISCELLANEOUS INDICATIONS

(a) Transliteration of the mark(this information is compulsory where

the mark consists of or contains matter in characters other than

Latin characters, or numerals other Arabic or Roman numerals) :

(b) Translation of the mark(as may be required by certain designated

Contracting Parties) :

(ⅰ) into English :

(ⅱ) into French :

(c) □ The words contained in the mark have no meaning (and therefore

cannot be translated)

(d) Where applicable, check the relevant box or boxes below

□ Three-dimensional mark

□ Sound mark

□ Collective mark, certifification mark, or guarantee mark

(e) Description of the mark (where applicable) :

(f) verbal element of the mark(where applicable) :

(g) The applicant declares that he wishes to disclaim protection for

the following element(s) of the mark :

[10] (a) GOODS AND SERVICES

(a) indicate below the goods and services for which the international

registration is sought :

Class                       Goods and services

(b) □The applicant wishes to limit the list of goods and services in

respect of one or more designated Contracting Parties, as follow-

ing :

Class(es) or list of goods and services for

Contracting Party       which protection is sought in this Contracting

Praty

□ If the space provided is not sufficient, check the box and use a continuation sheet
[11] DESIGNATED CONTRACTING PARTIES Check the corresponding boxes : ℓ
□AG Antigua and Barbuda □AL Albania □AM Armenia □AN Netherlands Antilles □AT Austria □AU Australia □BG Bulgaria □BT Bhutan □BX Benelux □BY Belarus □CH Switzerland □CN China □CU Cuba □CY Cyprus □CZ Czech Republic □DE Germany □DK Denmark □EE Estonia □ES Spain □FI Finland □FR France	□GB United Kingdom □GE Georgia □GR Greece □HU Hungary ℓ □IE Ireland □IS Iceland □IT Italy □JP Japan □KE Kenya □KP Democratic Peoples Repub- lic of Korea □KR Republic of Korea □LI Liechtenstein □LS Lesotho □LT Lithuania □LV Latvia □MA Morocco □MC Monaco □MD Republic of Moldova □MK The former Yugo- slv Rep, of Mac- edonia	□MN Mongolia □MZ Mozambique □NO Norway □PL Poland □PT Portugal □RO Romania □RU Russian Federation □SE Sweden ℓ □SG Singapore □SI Slovenia □SK Slovakia □SL Sierra Leone □SZ Swaziland □TM Turkmenistan □TR Turkey □UA Ukraine □US United States of 2 America □YU Serbia and Motene- gro □ZM Zambia
others: L By designating Ireland, Singapore or the United Kingdom, the appl- icant declares that he has the intention that the mark will be used by him or with his consent in that country in connection with the goods and services identified in this application.

2 If the United States of America is designated, it is compulsory to

annex to the present international application the official form

(MM18) containing the declation of intention to use the mark requi-

red by the Contracting Party.

[12] SIGNATURE BY THE APPLICANT OR HIS REPRESENTATIVE

(If required or allowed by the Office of origin)

(dd/mm/yyyy)

[13] CERTIFICATION AND SIGNATURE OF THE INTERNATIONAL APPLICATION BY THE OFFICE OF ORGIN

(a) Certification

The Office of origin certifies

(ⅰ) that the request to present this application was received on

(dd/mm/yyyy).

(ⅱ) that the applicant named in item 2 is the same as the applica-

nt named in the basic application or the holder named in the

basic registration mentioned in item 5, as the case may be,

that any indication given in item 8(c), 9(d) or 9(e) appears

also in the basic application or the basic registration, as

the case may be, that the mark in item 7(a) is the same as in

the basic application or the basic registration, as the case

may be that, if color is claimed as a distinctive feature of

the mark in the basic application or the basic registration,

the same claim is included in item 8 or that, if color is cla-

imed in item 8 without having being claimed in the basic appl-

ication or the basic registration, the mark in the basic appl

ication or the basic registration is in fact in the color or

combination of colors claimed, and that the goods and services

listed in item 10 are covered by the list of goods and servi-

ces appearing in the basic application or the basic registra-

tion, as the case may be.

Where the international application is based on two or more basic

application or basic registrations, the above declaration shall be

deemed to apply to all thoes basic application or basic registrati-

on.

(b) Office's signature :

Date of the signature :                        (dd/mm/yyyy)

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 if the reproduction of the mark is in black and white only; 903 Swiss francs if there is a reproduction in color) Complementary and supplementary fees Number of de- signations for Total amount of which comple- the complemen- mentary fee is Complementary tary fees applicable fee 73 Swiss francs × ＝ ＝＞ Number of cla- sses of goods Total amount of and services Supplementary the supplemen- beyond three fee 73 Swiss tary fees francs × ＝ ＝＞ Individual fees(Swiss francs) :
	Designated Designated Contracting Individual fee Contracting Individual fee Parties Parties

Total individual fees ＝〉

Grand total

Identity of the party effecting the payment:

Payment received and    WIPO receipt number

acknowledged by WIPO □

Payment made by         Check identification      dd/mm/yyyy

banker's cheque        □

(attached)

Payment made by         Check identification      dd/mm/yyyy

banker's cheque        □

(sent separately)

Payment made to WIPO    payment identification    dd/mm/yyyy

bank account CH35     □

0425 1048 7080 8100 0

Credit Suisse, CH-1211

Geneva 70

Swift : CRESCH ZZ12A

Payment made to WIPO    payment identification    dd/mm/yyyy

postal check account   □

No 12-5000-8, Geneva

CONTINUATION SHEET         No:        of