MM11(E) RENEWAL OF THE INTERNATIONAL REGISTRATION For use by the holder For use by the Office This renewal contains the following number of continuation sheets: Office s reference: Holder s reference: 1 INTERNATIONAL REGISTRATION NUMBER 2 NAME OF THE HOLDER (as recorded in the International Register)
MM11(E), page 2 3 CONTRACTING PARTIES FOR WHICH RENEWAL IS REQUESTED You must indicate below ALL the designated Contracting Parties for which you want to renew this international registration. You may renew the international registration in respect of a Contracting Party that has refused protection for all goods and services, following the recording of a statement sent under Rule 18ter of the Common Regulations. The registration will be renewed in respect of that Contracting Party for all the goods and services, by filling in this item solely. This may be useful, pending the outcome of further proceedings in the Contracting Party concerned. You may also renew the international registration in respect of a Contracting Party that has refused protection for some of the goods and services, following the recording of a statement sent under the aforementioned Rule, by filling in this item solely. The registration will be renewed in respect of that Contracting Party for only the goods and services protected. However, if you want to renew the international registration in respect of this Contracting Party for all goods and services, you must, in addition to this indication, provide the indication required in item 4 of this form. AG Antigua and Barbuda AL Albania AM Armenia AT Austria AU Australia AZ Azerbaijan BA Bosnia and Herzegovina BG Bulgaria BH Bahrain BN Brunei Durassalam BQ Bonaire, Saint Eustatius and Saba 1 BT Bhutan BW Botswana BX Benelux BY Belarus CH Switzerland CN China CO Colombia CU Cuba CW Curaçao 1 CY Cyprus CZ Czechia DE Germany DK Denmark DZ Algeria EE Estonia EG Egypt EM European Union 2 ES Spain FI Finland FR France GB United Kingdom GE Georgia GH Ghana GM Gambia GR Greece HR Croatia HU Hungary IE IL IN IR IS IT Ireland Israel India Iran (Islamic Republic of) Iceland Italy JP Japan KE Kenya KG Kyrgyzstan KH Cambodia KP Democratic People s Republic of Korea KR Republic of Korea KZ Kazakhstan LA Lao People s Democratic Republic LI Liechtenstein LR Liberia LS Lesotho LT Lithuania LV Latvia MA Morocco MC Monaco MD Republic of Moldova ME Montenegro MG Madagascar MK The former Yugoslav Rep. of Macedonia MN Mongolia MX Mexico MZ Mozambique NA Namibia NO Norway NZ New Zealand OA African Intellectual Property Organization (OAPI) 3 OM Oman PH Philippines PL Poland RS Serbia RU Russian Federation RW Rwanda SD Sudan SE Sweden SG Singapore SI Slovenia SK Slovakia SL Sierra Leone SM San Marino ST Sao Tome and Principe SX Sint Maarten (Dutch part) 1 SY Syrian Arab Republic SZ Swaziland TH Thailand TJ Tajikistan TM Turkmenistan TN Tunisia TR Turkey UA Ukraine US United States of America UZ Uzbekistan VN Viet Nam ZM Zambia ZW Zimbabwe PT Portugal RO Romania Others: 1 Territorial entity previously part of the Netherlands Antilles. 2 The designation of the European Union covers the following Member States: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, United Kingdom. 3 The designation of the African Intellectual Property Organization covers the following Member States: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Comoros, Congo, Côte d Ivoire, Equatorial Guinea, Gabon, Guinea, Guinea-Bissau, Mali, Mauritania, Niger, Senegal, Togo.
MM11(E), page 3 4 RENEWAL FOR ALL GOODS AND SERVICES IN RESPECT OF CONTRACTING PARTIES WHERE PROTECTION HAS BEEN PARTIALLY REFUSED, FOLLOWING THE RECORDING OF A STATEMENT SENT UNDER RULE 18TER OF THE COMMON REGULATIONS You may still renew the international registration for all goods and services in respect of a Contracting Party that has partially refused protection, following the recording of a statement sent under Rule 18ter. You must indicate below the Contracting Parties in respect of which you want to renew the international registration for all goods and services, despite the fact that protection has been partially refused, following the recording of the aforementioned statement. This may be useful, pending the outcome of further proceedings in the Contracting Party concerned. An indication provided below will not be taken into account if the Contracting Party concerned has not been indicated in item 3 of this form. AG Antigua and Barbuda AL Albania AM Armenia AT Austria AU Australia AZ Azerbaijan BA Bosnia and Herzegovina BG Bulgaria BH Bahrain BN Brunei Durassalam BQ Bonaire, Saint Eustatius and Saba 1 BT Bhutan BW Botswana BX Benelux BY Belarus CH Switzerland CN China CO Colombia CU Cuba CW Curaçao 1 CY Cyprus CZ Czechia DE Germany DK Denmark DZ Algeria EE Estonia EG Egypt EM European Union 2 ES Spain FI Finland FR France GB United Kingdom GE Georgia GH Ghana GM Gambia GR Greece HR Croatia HU Hungary IE IL IN IR IS IT Ireland Israel India Iran (Islamic Republic of) Iceland Italy JP Japan KE Kenya KG Kyrgyzstan KH Cambodia KP Democratic People s Republic of Korea KR Republic of Korea KZ Kazakhstan LA Lao People s Democratic Republic LI Liechtenstein LR Liberia LS Lesotho LT Lithuania LV Latvia MA Morocco MC Monaco MD Republic of Moldova ME Montenegro MG Madagascar MK The former Yugoslav Rep. of Macedonia MN Mongolia MX Mexico MZ Mozambique NA Namibia NO Norway NZ New Zealand OA African Intellectual Property Organization (OAPI) 3 OM Oman PH Philippines PL Poland PT Portugal RO Romania RS Serbia RU Russian Federation RW Rwanda SD Sudan SE Sweden SG Singapore SI Slovenia SK Slovakia SL Sierra Leone SM San Marino ST Sao Tome and Principe SX Sint Maarten (Dutch part) 1 SY Syrian Arab Republic SZ Swaziland TH Thailand TJ Tajikistan TM Turkmenistan TN Tunisia TR Turkey UA Ukraine US United States of America UZ Uzbekistan VN Viet Nam ZM Zambia ZW Zimbabwe Others: 1 Territorial entity previously part of the Netherlands Antilles. 2 The designation of the European Union covers the following Member States: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, United Kingdom. 3 The designation of the African Intellectual Property Organization covers the following Member States: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Comoros, Congo, Côte d Ivoire, Equatorial Guinea, Gabon, Guinea, Guinea-Bissau, Mali, Mauritania, Niger, Senegal, Togo. 5 SIGNATURE By signing this form, I declare that I am entitled to sign it under the applicable law: Name: Signature:
MM11(E), page 4 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 Basic fee (653 Swiss francs) Where applicable, surcharge for the grace period (326.50 Swiss Francs) Complementary and supplementary fees: Number of designations for which complementary fee is applicable Number of classes of goods and services beyond three x x Complementary fee 100 Swiss francs Supplementary fee 100 Swiss francs Total amount of the complementary fees = => Total amount of the supplementary fees = => Individual fees (Swiss francs): Designated Contracting Parties Individual fee Designated Contracting Parties Individual fee Total individual fees => GRAND TOTAL (Swiss francs) (c) METHOD OF PAYMENT Identity of the party effecting the payment: Payment received and acknowledged by WIPO Payment made to WIPO bank account IBAN No. CH51 0483 5048 7080 8100 0 Crédit Suisse, CH-1211 Geneva 70 Swift/BIC: CRESCHZZ80A Payment made to WIPO postal account (within Europe only) IBAN No. CH03 0900 0000 1200 5000 8 Swift/BIC: POFICHBE WIPO receipt number Payment identification Payment identification dd/mm/yyyy dd/mm/yyyy
CONTINUATION SHEET No:... of...
特許庁へ支払う手数料の納付書記載見本 dd/mm/yyyy Holder's name: International registration number: Holder's reference: 特許印紙特許印紙特許印紙 (4,200Yen) ( 注 ) 用紙は A4 判で作成して下さい