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Last updated: 03/2016 APPLICATION FOR A DECLARATION OF INVALIDITY Number pages (including this one) Applicant/representative reference (not more than 20 characters) Mod.011 Applicant Name legal entity or first name and surname Legal form the entity Tel, fax, email Address Street and number City and postal code Country Postal address (if different) Nationality Representative Name Tel, fax, email Address Street and number City and postal code Country Postal address (if different) ID number ID number multiple applicants multiple representatives Type representative legal practitioner pressional representative association representatives employee Challenged European Union trade mark EUTM No IR No Date registration (DD/MM/YYYY) / / Name and address EUTM proprietor Language the cancellation proceedings ES DE EN FR IT Extent the application against all the goods and services in the challenged registration against part the goods and services in the challenged registration, namely: Declaration I declare that a cancellation request relating to the same subject matter and cause action, and involving the same parties, has not been adjudicated on by a court in a Member State and has acquired the authority a final decision. I further declare that I have not previously applied for a cancellation based on another earlier right. Invalidity fee Total 630 Current account with EUIPO Account No Do not use my current account with EUIPO Signature Name Signature Transfer to EUIPO account Banco Bilbao Vizcaya Argentaria #TM011EN La Caixa Date transfer (DD/MM/YYYY) / / 1

GROUNDS Absolute grounds for invalidity Article 52(1)(a) EUTMR - European Union trade mark registered in breach Article 7 EUTMR Article 7(1)(a) EUTMR Article 7(1)(b) EUTMR Article 7(1)(c) EUTMR Article 7(1)(d) EUTMR Article 7(1)(e) EUTMR Article 7(1)(f) EUTMR Article 7(1)(g) EUTMR Article 7(1)(h) EUTMR Article 7(1)(i) EUTMR Article 7(1)(j) EUTMR Article 7(1)(k) EUTMR Article 7(1)(l) EUTMR Article 7(1)(m) EUTMR Article 52(1)(b) EUTMR - Applicant was acting in bad faith when filing the application Article 74 EUTMR - European Union collective mark registered in breach Article 68 EUTMR Reasoned statement Relative grounds for invalidity Article 53(1) EUTMR - European Union trade mark registered contrary to Article 8 EUTMR Article 53(2) EUTMR - European Union trade mark registered contrary to any other earlier rights For relative grounds, fill out the details the appropriate right(s) on the next pages 2

TRADE MARK REGISTRATION/APPLICATION - Article 8(1) and (5) EUTMR Identification the earlier mark Trade mark registration Trade mark application EU trade mark National trade mark International registration with effect in one or more Member State(s) Territory / Member State(s) BX CZ DK DE EE IE EL ES FR HR IT CY LV LT HU MT AT PL PT RO SI SK FI SE UK Filing date (DD/MM/YYYY) Filing number Word mark / / Registration date (DD/MM/YYYY) / / Registration number Goods and services on which the application is based: Representation the mark (in colour if applicable) all the goods and services covered by the registration/application part the goods and services covered by the registration/ application, namely: Entitlement applicant Owner Authorised licensee Copy registration/application Translation - The EUTM is identical to the earlier mark and covers identical goods and/or services - There is a likelihood confusion on the part the public - The use without due cause the contested mark would take unfair advantage, or be detrimental to, the distinctive character or the repute the earlier trade mark Territory/Member State(s) where the earlier mark has a reputation: BX CZ DK DE EE IE EL ES FR HR IT CY LV LT HU MT AT PL PT RO SI SK FI SE UK Goods and services for which the trade mark has a reputation all the goods and services covered by the registration/application part the goods and services covered by the registration/application, namely: Evidence reputation translation

WELL-KNOWN TRADE MARK (Article 6bis the Paris Convention) - Article 8(2)(c) EUTMR Member State/s where the trade mark is well known BE CZ DK DE EE IE EL ES FR HR IT CY LV LT LU HU MT NL AT PL PT RO SI SK FI SE UK Representation the mark (in colour if applicable) Word mark The application is based on the following goods and services for which the trade mark is well known - The EUTM is identical to the earlier mark and covers identical goods and/or services - There is a likelihood confusion on the part the public Explanation grounds and other remarks Evidence the mark being well known translation

CONTESTED APPLICATION FILED BY AN AGENT OF THE APPLICANT - Article 8(3) EUTMR The applicant is the owner a Registered trade mark Registration number Date registration (DD/MM/YYYY) / / Trade mark application Filing number Date filing (DD/MM/YYYY) / / Non-registered trade mark Registered/applied/protected in the following country/countries Representation the mark (in colour if applicable) Word mark The trade mark/application the applicant covers the following goods Article 53(1)(b) EUTMR - The applicant is the proprietor the trade mark on which the application is based and the owner is/was an agent or representative the applicant and applied for registration there in his or her own name without the applicant s consent. Explanation grounds and other remarks Evidence entitlement to the trade mark: Evidence the owner being an agent or representative for the applicant: Translation

NON-REGISTERED TRADE MARK OR SIGN USED IN THE COURSE OF TRADE - Article 8(4) EUTMR Nature rights Entitlement Non-registered trade mark Trade name Company name Other (specify) Owner Person authorised under the applicable law Territory / Member State(s) where the trade mark or sign is used in the course trade BE CZ DK DE EE IE EL ES FR HR IT CY LV LT LU HU MT NL AT PL PT RO SI SK FI SE UK Mark or sign in words Representation the mark or sign (in colour if applicable) Goods, services or activities for which the mark/sign is used Article 53(1)(c) EUTMR The earlier non-registered trade mark/sign is used in the course trade, is more than mere local significance and, pursuant to the law governing it, the trade mark/sign confers on its proprietor the right to prohibit the use a subsequent trade mark. Explanation grounds and other remarks Evidence use/protection, including the applicable law translation

OTHER EARLIER RIGHTS - Article 53(2)EUTMR Nature the right a right to a name (Article 53(2)(a) EUTMR) a right personal portrayal (Article 53(2)(b) EUTMR) a copyright (Article 53(2)(c) EUTMR) an industrial property right (Article 53(2)(d) EUTMR) any other earlier right (Article 53(2) EUTMR) Particulars the right Registration No (if applicable) Registration date (if applicable) Territory/Member State(s) where the right is protected BE CZ DK DE EE IE EL ES FR HR IT CY LV LT LU HU MT NL AT PL PT RO SI SK FI SE UK Representation the right (in colour if applicable) Entitlement Owner Person authorised under the applicable law Explanation grounds and other remarks Evidence use/protection, including the applicable law translation Check that the form has been signed on page 1

BASIS OF DECLARATION OF INVALIDITY: PROTECTED DESIGNATION OF ORIGIN OR GEOGRAPHICAL INDICATION Nature rights Protected geographical indication Protected designation origin Entitlement Person authorised under the applicable law Territory / Member State(s) where the trade mark or sign is used in the course trade BE CZ DK DE EE IE EL ES FR HR IT CY LV LT LU HU MT NL AT PL PT RO SI SK FI SE UK PGI/PDO in words Goods and services for PGI/PDO Article 53(1)(d) EUTMR The earlier right is a protected designation origin or a geographical indication or an application for a designation origin or a geographical indication and, pursuant to the law governing it, that designation origin or geographical indication confers on the person authorised the right to prohibit the use a subsequent trade mark Explanation grounds and other remarks Evidence protection, including the applicable law translation