[별지 제23호서식] 국제출원서
MM2(E) 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)
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 : interg.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 following number of continuation sheets :......		For use by the applicant/Office Applicant’s reference :....................... Office’s reference :............................
CONTRACTING PARTY WHOSE OFFICE IS THE OFFICE OF ORIGIN :...............
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 :...................................

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 in 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 in 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

...............................................................................................................................

...............................................................................................................................

REPRESENTATIVE(if any)

Name :...............................................................................................................

...........................................................................................................................

Address :...........................................................................................................

...........................................................................................................................

Telephone :...........................................Fax :....................................................

E-mail address :...............................................................................................

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)

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 to which it does relate : ........................................................................................................................ ........................................................................................................................ □If several priorities are claimed, check box and use a continuation sheet giving the above required information for each priority claimed.
THE MARK
(a) Place the reproduction of the mark, as it appears in the basic application or 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 a color or a combination colors as such.
	Where the Office of origin has addressed this form by telefacsimile, 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:.................................................................
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 Contracting Parties) : ........................................................................................................................... ........................................................................................................................... ...........................................................................................................................

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, certification 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 :

........................................................................................................................

........................................................................................................................

GOODS AND SERVICES

(a) Indicate below the goods and services for which 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 following : Contracting Party Class(es) or list of goods and services for which protection is sought in this Contracting Party ............................................. ........................................................................... ............................................. ........................................................................... ............................................. ........................................................................... ............................................. ........................................................................... ............................................. ........................................................................... ............................................. ........................................................................... ............................................. ........................................................................... ............................................. ........................................................................... ............................................. ........................................................................... ............................................. ........................................................................... □If the space provided is not sufficient, check the box and use a continuation sheet
□ DESIGNATED CONTRACTING PARTIES Check the corresponding boxes :
□AG Antigua and	□GB United Kingdom¹	donia
Barbuda	□GE Georgia	□MN Mongolia
□AL Albania	□GR Greece	□MZ Mozambique
□AM Armenia	□HU Hungary	□NO Norway
□AN Netherlands	□IE Ireland¹	□PL Poland
Antilles	□IS Iceland	□PT Portugal
□AT Austria	□IT Italy	□RO Romania
□AU Australia	□JP Japan	□RU Russian Federa-
□BG Bulgaria	□KE Kenya	tion
□BT Bhutan	□KP Democratic Peo-	□SE Sweden
□BX Benelux	ple’s Republic of Korea	□SG Singapore¹

□BY Belarus	□KR Republic of Korea	□SI Slovenia
□CH Switzerland	□LI Liechtenstein	□SK Slovakia
□CN China	□LS Lesotho	□SL Sierra Leone
□CU Cuba	□LT Lithuania	□SZ Swaziland
□CY Cyprus	□LV Latvia	□TM Turkmenistan
□CZ Czech Republic	□MA Morocco	□TR Turkey
□DE Germany	□MC Monaco	□UA Ukraine
□DK Denmark	□MD Republic of Mol-	□US Untied States of
□EE Estonia	dova	America²
□ES Spain	□MK The former Yugo	□YU Serbia and
□FI Finland	-slav Rsp. of Mace-	Montenegro
□FR Francw		□ZM Zambia
others :
........................................ ........................................ ........................................ ........................................ ........................................ ........................................
¹ By designating Ireland, Singapore or the United Kingdom, the applicant 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 (MM10) containing the declaration of intention to use the mark required by the Contracting Party.
SIGNATURE BY THE APPLICANT OR HIS REPRESENTATIVE (If required or allowed by the Office of origin) .............................................................................. .................(dd/mm/yyyy)
CERTIFICATION AND SIGNATURE OF THE INTERNATIONAL APPLICATION BY THE OFFICE OF ORIGIN (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 applicant 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 tioned 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 claimed in item 8 without having being claimed in the basic application or the basic registration, the mark in the basic application or the basic registration is in fact in the color or combination of colors claimed, and that the gooks and services listed in item 10 are covered by the list of goods and services appearing in the basic application or the basic registration, 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 registration.

(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 designa- tions for which com- plementary fee is ap- Total amount of the plicable Complementary fee complementary fees ..............................×73 Swiss francs =.......................⇒............................. Number of classes of goods and services Total amount of the beyond three Supplementary fee supplementary fees ..............................×73 Swiss francs =.......................⇒............................. Individual fees(Swiss francs) :
	Designated Con- Individual fee Designated Con- Individual fee tracting Parties tracting Parties ............................ ....................... ............................ ......................... ............................ ....................... ............................ .........................
Total individual fees ⇒................................. Grand total ................................. Identity of the party effecting the payment :.................................................... Payment received and ac- WIPO receipt number knowledged by WIOP □.......................................... Payment made by banker’s Check identification dd/mm/yyyy cheque(attached) □................................... ............................. Payment made by banker’s Check identification dd/mm/yyyy cheque(sent separately) □................................... ............................. Payment made to WIPO Check identification dd/mm/yyyy bank account No CH35 □................................... ............................ 0452 1048 7080 8100 0 Cred- it Suisse, CH-1211 Geneva 70 Swift : CRESCH ZZ12A Payment made to WIOP Payment identification dd/mm/yyyy Postal check account No □................................... ........................... 12-5000-8, Geneva

CONTINUATION SHEET

No : ...................of..............