放棄の記録の請求 DM/5 D

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Dustin Kelly
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1 M/5- 放棄の記録の請求 DM/5 D

2 DM/5 (E) HAGUE AGREEMENT CONCERNING THE INTERNATIONAL REGISTRATION OF INDUSTRIAL DESIGNS REQUEST FOR THE RECORDING OF A RENUNCIATION IMPORTANT 1. One single form may be used to request the recording of a renunciation in respect of several international registrations of the same holder, provided that the designated Contracting Parties in respect of which the international registration is renounced are the same for each of the international registrations concerned. 2. The request must necessarily relate to all the industrial designs covered by the international registration(s) (in respect of some or all designated Contracting Parties). If the request relates to some only of the industrial designs, form DM/3 (limitation) must be used instead. This cover page must not be sent to the International Bureau. World Intellectual Property Organization 34, chemin des Colombettes, P.O. Box 18, 1211 Geneva 20, Switzerland Tel.: +41 (0) Fax (The Hague Registry): +41 (0) Internet:

3 特許庁参考訳 DM/5(E) 意匠の国際登録に関するハーグ協定放棄の記録の請求重要 1. 同一名義人の複数の国際登録について放棄の記録を請求するために本様式を用いることができるただし当該各国際登録に関して国際登録の放棄の対象となる指定締約国が同一でなければならない 2. 放棄の記録の請求は ( 一部又は全ての指定締約国について ) 必ず当該国際登録の対象となる全ての意匠に係るものでなければならない当該請求が国際登録の対象となる意匠の一部のみに係るものである場合はこの様式に代えて様式 DM/3 ( 限定 ) を用いなければならないこの表紙は国際事務局へ送付してはならない

4 REQUEST FOR THE RECORDING OF A RENUNCIATION DM/5 (E) For use by the holder This request contains the following number of continuation sheets: For use by the International Bureau Reference: 1 INTERNATIONAL REGISTRATION NUMBER(S) 2 NAME OF THE HOLDER (as recorded in the International Register) 3 APPOINTMENT OF A REPRESENTATIVE (optional) (do not complete this item if there is no change in the representative already recorded in the International Register) Name: Address: Telephone: address: Fax: (c) To appoint a representative, the present request must be signed by the holder, or be accompanied by a power of attorney or form DM/7 (check the appropriate box): item 5 of the request is signed by the holder; or a power of attorney or form DM/7 is attached to the present form 4 CONTRACTING PARTIES (check either or ) AL Albania AM Armenia AZ Azerbaijan BA Bosnia and Herzegovina BG Bulgaria BJ Benin BN Brunei Darussalam BQ Bonaire, Sint Eustatius and Saba * BW Botswana BX Benelux BZ Belize CH Switzerland CI Côte d Ivoire CW Curaçao * DE Germany DK Denmark EE Estonia EG Egypt Others: The renunciation concerns all designated Contracting Parties; The renunciation concerns the following designated Contracting Parties: EM European Union ES Spain FI Finland FR France GA Gabon GB United Kingdom GE Georgia GH Ghana GR Greece HR Croatia HU Hungary IS Iceland IT Italy JP Japan KG Kyrgyzstan KH Cambodia KP Democratic People s Republic of Korea KR Republic of Korea LI Liechtenstein LT Lithuania LV Latvia MA Morocco MC Monaco MD Republic of Moldova ME Montenegro MK The former Yugoslav Rep. of Macedonia ML Mali MN Mongolia NA Namibia NE Niger NO Norway OA African Intellectual Property Office OM Oman PL Poland RO Romania RS Serbia RU Russian Federation RW Rwanda SG Singapore SI Slovenia SN Senegal SR Suriname ST Sao Tome and Principe SX Sint Maarten * SY Syrian Arab Republic TJ Tajikistan TM Turkmenistan TN Tunisia TR Turkey UA Ukraine US United States of America * Territorial entity previously part of the Netherlands Antilles

5 放棄の記録の請求 DM/5(E) 特許庁参考訳名義人用この請求は次の枚数の続葉を含む : 国際事務局用整理番号 : 1 国際登録番号 2 名義人の氏名又は名称 ( 国際登録簿の記録どおりに ) 3 代理人の選任 ( 任意 ) ( 既に国際登録簿に記録されている代理人に変更がない場合には本欄は空欄とする ) 氏名又は名称住所又は居所電話番号ファクシミリ番号電子メールアドレス (c) 代理人を選任するためには当該請求において名義人が署名又は委任状若しくは DM/7 を添付しなければならない ( 該当するボックスをチェックする ) 第 5 欄が名義人によって署名されている又は当該様式に委任状又は DM/7 を添付する 4 締約国 ( 又は ( のいずれかをチェックする ) 当該放棄はすべての指定締約国に対するもの当該放棄は次の指定締約国に対するもの AL Albania AM Armenia AZ Azerbaijan BA Bosnia and Herzegovina BG Bulgaria BJ Benin BN Brunei Darussalam BQ Bonaire, Sint Eustatius and Saba * BW Botswana BX Benelux BZ Belize CH Switzerland CI Côte d Ivoire CW Curaçao * DE Germany DK Denmark EE Estonia EG Egypt その他 EM European Union ES Spain FI Finland FR France GA Gabon GB United Kingdom GE Georgia GH Ghana GR Greece HR Croatia HU Hungary IS Iceland IT Italy JP Japan KG Kyrgyzstan KH Cambodia KP Democratic People s Republic of Korea KR Republic of Korea LI Liechtenstein LT Lithuania LV Latvia MA Morocco MC Monaco MD Republic of Moldova ME Montenegro MK The former Yugoslav Rep. of Macedonia ML Mali MN Mongolia NA Namibia NE Niger NO Norway OA African Intellectual Property Office OM Oman PL Poland RO Romania RS Serbia RU Russian Federation RW Rwanda SG Singapore SI Slovenia SN Senegal SR Suriname ST Sao Tome and Principe SX Sint Maarten * SY Syrian Arab Republic TJ Tajikistan TM Turkmenistan TN Tunisia TR Turkey UA Ukraine US United States of America * オランダ領アンティルを構成していた地域

6 5 SIGNATURE AND/OR SEAL (c) (d) Identify the signatory by checking the appropriate box: (i) Holder (ii) Name: Representative of the holder Signature and/or seal: Date of signature (): Name of the person to contact, if necessary: PAYMENT OF FEES 1. INSTRUCTION TO DEBIT FROM A WIPO CURRENT ACCOUNT (if this box is completed, it is not necessary to complete item 2 below) The International Bureau is hereby instructed to debit the required amount of fees from the following WIPO current account: Holder of the account: Account number: Identity of the party giving the instruction: 2. AMOUNT OF FEES; METHOD OF PAYMENT Amount (144 Swiss francs) (per international registration mentioned in item 1) Grand total (Swiss francs) Identity of the party effecting the payment: Payment made to WIPO bank account IBAN No. CH Credit Suisse, CH-1211 Geneva 70 Swift/BIC: CRESCHZZ80A Payment made to WIPO postal account IBAN No. CH Swift/BIC: POFICHBE Payment identification Payment identification

7 5 署名及び / 又は印章の押印該当するボックスをチェックすることによる署名者の特定 (i) 名義人 (ii) 名義人の代理人 (c) (d) 氏名又は名称署名及び / 又は印章の押印署名日 () 必要であれば担当者の氏名又は名称手数料の支払 1. 開設された WIPO 口座からの引き落としについての指示 ( この欄を記載した場合には以下の 2 を記載する必要はない ) 国際事務局は必要額の手数料を以下の WIPO 口座から引き落すよう指示を受ける : 口座名義人 : 口座番号 : 指示をする当事者の特定 : 2. 手数料の額 ; 支払方法金額 (144 スイスフラン ) ( 第 1 欄に記載された国際登録ごと ) 総額 ( スイスフラン ) 支払を行う当事者の特定 WIPO の銀行口座への支払 IBAN No. CH Credit Suisse, CH-1211 Geneva 70 Swift/BIC: CRESCHZZ80A WIPO の郵便口座への支払 IBAN No. CH Swift/BIC: POFICHBE 支払の特定支払の特定

HAGUE AGREEMENT CONCERNING THE INTERNATIONAL REGISTRATION OF INDUSTRIAL DESIGNS APPLICATION FOR INTERNATIONAL REGISTRATION IMPORTANT

DM/1(E) HAGUE AGREEMENT CONCERNING THE INTERNATIONAL REGISTRATION OF INDUSTRIAL DESIGNS APPLICATION FOR INTERNATIONAL REGISTRATION IMPORTANT 1. The international application may contain several industrial