[별지 제20호서식] <개정 2004.5.1> 국제등록명의변경등록신청서
MM5(E) MADRID AGREEMENT AND PROTOCOL CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS REQUEST FOR THE RECORDING OF A CHANGE IN OWNERSHIP (Rule 25 of the Common Regulations)
	IMPORTANT : 1. If the present request relates to a total change in ownership, as provided for in item 6(a), this form may be used for several international registrations in the name of the same holder. 2. If the present request relates to a partial change in ownership, as provided for in item 6(b), this form may only be used to reque- st the recording of a change in ownership for single international registration. 3. This request may be presented to the international Bureau directly by the recorded holder, or by the Office of the Contracting Party of the recorded holder or by the Office of a Contracting Party of the new owner(the transferee).
[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

REQUEST FOR THE RECORDAL OF A CHANGE IN OWNERSHIP
For use by the holder This renewal contains the following number of continuation sheet :		For use by the holder/Office Holder's reference : Office's reference :
[1] INTERNATIONAL REGISTRATION NUMBER(S) (several international registration numbers may be indicated below, provided that all registrations concerned are the subject of a total change in ownership as provided for in item 6(a))
[2] NAME OF THE HOLDER (as recorderd in the International Register)
[3] NEW OWNER(transferee) (a) Name : (b) Address : (c) Address for correspondence : (d) Telephone : Fax: E-mail address :
[4] ENTITLEMENT OF THE TRANSFEREE TO BE THE HOLDER OF THE INTERNATIONAL REGISTRATION (a) Indicate in the appropriate space(S) : (ⅰ) the name of the Contracting State of which the transferee is a national; and/or, (ⅱ) the name of the State member of a Contracting Organization of which the transferee is a national; and/or, (ⅲ) the name of the Contracting Party in the territory of which the transferee is domiciled; and/or, (ⅳ) the name of the Contracting Party in the territory of which

the transferee has a real and effective industrial or

commercial establishment.

(b) Where the transferee is not a national of a Contracting State or

of a State member of a Contracting Organization and the address

given in item 3(b) is not in the territory of any of the

Contracting Parties mentioned in paragraph (a)(ⅲ) or (ⅳ) of the

present item, indicate in the space provided below :

(ⅰ) the domicile of the transferee in the territory of any of the

Contracting Parties mentioned in paragraph (a)(ⅲ) of the

present item, or,

(ⅱ) the address of the transferees industrial or commercial

establishment in the territory of any of the Contracting Party

mentioned in paragraph (a)(ⅳ) of the present item.

[5] APPOINTMENT OF A REPRESENTATIVE BY THE NEW OWNER(optional)

Name :

Address :

Telephone :

Fax :                          E-mail address :

SIGNATURE OF THE NEW OWNER APPOINTING THE ABOVE REPRESENTATIVE

[6] SCOPE OF THE CHANGE IN OWNERSHIP(check either (a) or (b))

(a) □ TATAL CHANGE IN OWNERSHIP (the change in owership is to be

recorded for all the Contracting parties designated in the

international registration(s) indicated in item 1, and for all

the goods and services corverd by such internarional

registration(s)) :

(b) □ PARTIAL CHANGE IN OWNERSHIP(read note No.2 on the cover page before checking this box)

(ⅰ) the change in ownership is to be recorded for the designa-

ted Contracting Parties indicated below (if no Contracting

Party is indicated, it will be understood that the change

in ownership is to be recorded in respect of all the

designated Contracting Parties) : and/or,

(ⅱ) the change in ownership is to be recorded for the goods

and services indicated below(grouped in the appropriate

classes) ; if no goods services are indicated, it will be

understood that the change in ownership is to be recorded

in respect of all goods and services.

□ If the space provided is not sufficient, check this box and use a

continuation sheet

[7] MISCELLANEOUS INDICATIONS

(a) Indications concerning the transferee(as may be required by certain

designated Contracting Parties) :

(ⅰ) if the transferee is a natural person, nationality of the trans-

feree:

(ⅱ) if the transferee 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 :

(b) The transferee may choose a preferred language for correspondence :

□ English       □ French

[8] SIGNATURE BY THE HOLDER OR HIS REPRESENTATIVE

Holder                             Representative of the holder

(as recorded in the International  (as recorded in the International

Register)                          Register)

Name :                           Name :

Signature :                       Signature :

[9] OFFICE RESENDTING THE REQUEST(if applicable)

Name of the office

Signature and/or stamp of the office

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

(per international

Amount(177 Swiss francs) ×         registration mentioned

in item 1)

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 No 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 cheque account □

No 12-5000-8, Geneva

CONTINUATION SHEET         No:        of