(FOR OFFICIAL USE ONLY) (FOR OFFICIAL USE ONLY) TRADE MARK APPLICATION NUMBER: (This No. is allocated by the Designated Office) NO. ALLOCATED BY RECEIVING OFFICE: DATE OF FILING ISSUED BY DESIGNATED OFFICE: DATE OF RECEIPT If and wherever applicable, please check the relevant boxes below: Any Associated Trade Marks? 1 Is the application for a certification trade mark? 2 Is the application for a collective trade mark? 3 Is the application for a defensive mark? 4 PART I DESIGNATED COUNTRIES Brunei Darussalam Cambodia Indonesia Lao P.D.R. Malaysia Myanmar Philippines Singapore Thailand Vietnam * Please note that special conditions are to be complied with in some designated countries. PART II APPLICANT (a) Name: (b) Address: (c) Nationality or Citizenship/Country of Incorporation: 1 Please indicate the associated trade marks on a separate sheet which is to be attached to this Form. However, if the application is lodged in Singapore or Thailand, it is not necessary to indicate the associated trade marks. 2 & 3 Please note that there are special requirements relating to the filing of certification and collective trade marks in some ASEAN countries. 4 In the case of a defensive trade mark, a copy of the statement of case verified by statutory declaration, must be attached in Malaysia. Page 1 of 9
Part II (e) Agent & Address for Service Please give the name of your agent and your agent s address as the address for service. All communications will be directed to your agent only. In Lao P.D.R., Malaysia and Vietnam only approved agents can file and handle the application. For the list of approved agents please refer to the websites of Lao P.D.R., Malaysia and Vietnam. Part III (a) Representation of the trade mark The trade mark must be visually perceptible and capable of being represented graphically. The following guidelines are intended to assist applicants when filing applications. However, each application will be determined on its own merits and these guidelines are not conclusive. Shape marks Trade marks which consist of the three dimensional shape of goods or packaging may be represented by line drawings. Unless all aspects of the shape can be captured from a single view, multiple aspect views should be filed (preferably no more than 4). Description of rights claimed in mark A description of the rights claimed in the mark, eg The Applicant claims all rights in any word beginning with the letters EG is not acceptable as a graphical representation. (b) Specification of goods/services (i) Please specify the goods/services in respect of which registration is sought. Goods and services are classified using the International Classification of Goods and Services. Example: Acceptable specification: Class 25 Blouses, dresses, jackets, jeans, pants, shirts, shorts, skirts and T-shirts. (ii) You should not apply for all the goods or services in a class or for a large variety of goods or services within a class unless. h you can justify your claim; or h you are using the mark on all the goods or services applied for; or h you have a definite intention to do so. Page 2 of 9
(d) Description of Entity 5 (if applicant is not an individual): (e) Name of Local Agent and Address for Service for Each Designated Country 6 : Designated Countries Name of Agents and Agent s Registration No. (if applicable) Address For Service PART III DETAILS OF TRADEMARK APPLICATION (a) REPRESENTATION OF MARK 7 (b) GOODS/SERVICES 8 Class No. Specification : (FOR FILING IN MALAYSIA ONLY) Class No. Specification of Services 9 : 5 If the application is to be filed in Lao P.D.R. or Vietnam and the applicant is a company, please attach a copy of the Certificate of Incorporation or Operation. If the application is to be filed in Malaysia or Singapore and the applicant is a partnership, please furnish the names of all the partners. If the application is filed in the Philippines, and there are more than one applicant, all of them should be named as applicants but any one of them may sign the application for and on behalf of all the applicants. 6 If the space provided is insufficient, please attached the requisite information in a separate sheet attached to this Form. 7 The number of specimen of marks to be attached to this application must equal to the number of countries designated. 8 Please attach a separate sheet if the space provided is insufficient. In the case of Thailand, the applicant must itemise all the goods and services applied for. Separate fees are chargeable per item. 9 If Malaysia is designated, please refer to list attached for Classes 35 45. Page 3 of 9
Part III (contd) (d) Colour marks An application to register a trade mark i) consisting of a colour or colours or ii) consisting of or containing a shape or packaging which is coloured should be filed in the actual colour(s). (e) Examples of description i) The trade mark consists of the colours red, grey, white and blue ii) The trade mark consists of the colours yellow, blue, green and white as applied to the goods themselves. iii) The trade mark consists of the colours red, white and grey as applied to the packaging of the goods. (f) Description of the mark if the mark contains or consists of a device Examples: fire, fire extinguisher, window lion (i) Description of your claim to the particular feature in words. Examples: The trade mark consists of the 3-dimensional shape of a cigarette lighter with the word appearing thereon, as shown in the representation on the application form. The trade mark consists of the colours purple, red, blue and yellow as applied to the packaging of the goods as shown in the representation on the application form. Page 4 of 9
(c) Is the application for a series of trade marks 10? If so, a representation of each mark in the series must be given. Yes No (d) If the mark is a coloured mark, state whether the mark is to be limited to the colours as shown in the form. Yes No Note : Item (e) is only applicable if Lao P.D.R., Philippines and/or Vietnam is/ are designated. (e) If the mark is a coloured mark, please describe the colours of the mark. Note: Item (f) is only applicable if Brunei, Cambodia, Lao P.D.R., Philippines, Singapore, Thailand and/or Vietnam is/are designated. (f) If the mark consists of a device, please give a description of the device below. Note : Item (g) is only applicable if Brunei, Cambodia, Lao P.D.R., Malaysia, Philippines, Singapore, Thailand and/or Vietnam is/are designated. (g) Is the mark three-dimensional? 11 Yes No Note : Items (h ) is only applicable if Singapore and/or Thailand is/are designated. (h) colour(s) as a trade mark Please provide a description of your claim to the particular feature in words. Note : The items (i) and (j) are only applicable if Singapore is designated. (i) aspect of packaging If 3-dimensional shape or aspect of packaging is claimed, provide a description of your claim to the particular feature in words. 10 An application for a series of marks can be made if the trade marks are in respect of the same goods or services in one international class and they do not differ in material particulars but only in relation to nondistinctive matters such as description of the goods or services and the differing matters do not substantially affect the identity of the trade marks. However, in Cambodia and Vietnam, an application for a series of marks is not acceptable and separate applications have to be lodged. 11 If the mark is a three-dimensional mark, please attach 4 views (front, back, top and bottom) of the mark in a separate sheet to this application. An application to register a 3-dimensional shape or aspect of packaging as a trade mark will not be treated as such unless you tick the relevant box. Page 5 of 9
(j) Derivation of the mark. Example: The mark Kodak is an invented word with no meaning. (k) Translation/Transliteration If your trade mark consists of or contains words in a language other than English or foreign characters, please provide a certified translation and/or transliteration of such words or characters by a qualified translator (the courts in your country or the yellow pages may provide names of translators), and fill in the details at the relevant spaces. Example: (i) The French (specify language) word(s) appearing in the mark is/are bon (specify the non-english word(s) meaning good. (ii) The transliteration of the Chinese (specify language) character(s) appearing in the mark/of which the mark consists is meaning good. Part IV Notes for Priority Claim If you have applied to register a trade mark in a country which is obliged to follow the Paris Convention 1883 conferring a right of priority you are entitled to register the trade mark in the ASEAN countries which are the parties to the ASEAN Regional Filing System in priority to other applicants. The date of receipt in the Receiving Office shall be the date of application for registration in that priority country. However, you must file your application in the Receiving Office within 6 months from the date of the application in the priority country. Your claim to priority must be made at the time you file your application in the Receiving Office. Example: You applied for registration in Japan in 02/01/2002. You may claim priority if your application is filed in the Receiving Office by 02/07/2002. To claim priority, please insert Japan, 2 January 2002 in the relevant spaces on the application form. Part V Limitations or disclaimers You may voluntarily disclaim your rights to any element in your trade mark. Example: Registration of this trade mark shall give no right to the exclusive use of the word Good. You may also restrict your rights in the mark to particular colours. Page 6 of 9
(j) If the mark contains or consists of word(s), provide the derivation of the word(s) and state whether it is invented: (k) If the mark contains or consists of non-english word(s) and/or foreign character(s), provide the following details: (1) The word(s) appearing in the marks is meaning. (2) The transliteration of the characters appearing in the mark or of which the mark consists is meaning. PART IV PRIORITY CLAIM Note: A certificate by the registrar or the registering authority of the country in which the priority application is filed, must be attached as evidence of the priority claim. However, if the application is filed in Cambodia, Indonesia, Lao P.D.R., Malaysia, Philippines or Thailand, a certified copy of the priority documents will suffice. (a) Office of Priority filing: (b) Priority filing date : (dd/mm/yy) (c) Application Number, if available, if filed in Cambodia, Philippines or Vietnam Note : The item (d) is only applicable if Malaysia is designated. (d) Date of First Use of the Mark : PART V LIMITATIONS, CONDITIONS, E.T.C. Insert below any conditions, disclaimers or other limitations to which the registration will be subjected. Page 7 of 9
PART VI USE OR INTENTION TO USE 12 The Trade Mark is being used by the applicant or with his consent, in relation to the goods or services stated, or there is a bona fide intention that it will be so used. Kindly tick the appropriate box TM being used There is a bona fide intention to use the TM Signature & Date Note : The portion below need only be filled if Indonesia, Lao P.D.R., Malaysia and/or Vietnam is/are designated. Statutory Declaration 13 I/We claim to be the bone fide proprietor of the mark whose registration is applied for. I/We declare that this application is made in good faith and that I/We am/are entitled to be registered as the proprietor. And I make this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declaration Act (insert applicable legislation in each ASEAN country) Subscribed and solemnly declared by this day of 200 at Before: Commissioner of Oath/Notary Public Signature & Date Name 12 This part may be signed by an agent on behalf of the applicant(s). If the applicant is a partnership and the agent does not sign on behalf of the partnership, all the partners must sign and the full names of the partners must be stated. This PART VI is not needed, if filed in the Philippines. 13 If the declaration is made outside any of the designated countries, it is to be made before a court, judge, justice of the peace, magistrate, notary public or other officer authorised by law in the said territory to administer an oath for the purpose of any legal proceedings. An agent signing this part on behalf of an applicant must satisfy himself as to the truth of the declaration. If the applicant is a partnership and the agent does not sign the Statutory Declaration on behalf of the partnership, all the partners must sign and the full names of the partners must be stated Page 8 of 9
PART VII SIGNATURE OF THE APPLICANT OR HIS REPRESENTATIVE 14 (a) Signature: (b) Name of Signatory: (c) Date of Signature: PART VIII OFFICIAL FEES PART IX SUMMARY CHECKLIST 14 If this part is signed by an agent on behalf of the applicant, a Power of Attorney is required in all the countries except for Brunei and Singapore. In the case of Cambodia, Lao P.D.R., Malaysia, Philippines, Thailand and Vietnam, the Power of Attorney has to be attached. In the case of Myanmar, the Power of Attorney must be notarised and legalised Page 9 of 9