CTM2protect | Application form

Application form

Please fill in the form below, the fields marked by a * are mandatory fields.

Your contact details

Your reference:
Name of your firm/company:*
E-mail address:*
Contact person:*
Address:
Fax No.:

Languages

First language:
Second language:

Applicant

Type:* Legal entity Natural person
Name:*
Street and number:*
Postal code:*
City:*
Country:*
State of incorporation (if applicable):
Nationality:*

Trademark

Mark: (Attached in case of figurative or 3D mark)

Representation in case of Word mark

In case of Figurative mark please attach a representation in .jpeg format, not exceeding the size of 1 megabyte.

Indication of colour(s):

Description of the mark:

Disclaimer:

Collective mark: Regulation governing use of collective mark
attached to follow

List of goods and services:

Class No(s)*.

Goods and services*:

Priority claim

The applicant claims the priority of the earlier application(s) mentioned below:

Number:
Country of first filing:
Filing date: (day/month/year)
Certificate:
attached to follow
Certificate:

Translation in English:
attached to follow
Translation in English:

Seniority claim:
We recommend to claim only the seniority of earlier identical trademark registrations in EC-countries after the application has proceeded to registration.

Payment

Total fees:
1-3 classes: € 975
Extra class above 3rd class: € 225 per class

You will receive an invoice together with the confirmation of these instructions. You are kindly requested to transmit the amount of the invoice within two weeks after the invoice date by electronical wire to:

Account No.: 9640874
IBAN: NL 80 PSTB 0009 6408 74

In the name of :

Landmark B.V.
Stationsplein 325
3818 LE Amersfoort
The Netherlands

Bank: Postbank N.V. (part of ING Bank)

Swift code / BIC: PSTBNL21

Signature:

I declare that I will transmit the amount due for this application by electronical wire ithin two weeks after the invoice date and that all payment costs will be born by me/us (OUR COSTS).

Name*:
Capacity*:

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