The priority of more than one earlier application is claimed:

Yes

No
The data are indicated in the supplemental box** (at annex)
The certified copy of the earlier application is enclosed:

Yes

No
If No, it will be furnished by………………………………..……………………(date)

7.

Limitation/Disclaimer
Indicate

any

limitation

or

disclaimer…………………………………………………………………………………………..
………………………………………………………………………………………………
…………………………………….

8.

APPLICANT(S) (the data concerning each applicant must appear in this box or, if the
space is insufficient, in the supplemental box** - at annex).

FULL NAME

ADDRESS/TELEPHONE/FAX/E-

OF EACH

MAIL

NATIONALITY

RESIDENCE

APPLICANT
(Underline
surnames)

If the applicant is a corporate body, give country and, if applicable, State of incorporation

9.

Specification of Goods/Services (according to the Nice Classification)
If the space provided for the specification of goods/services is insufficient then please
continue on separate sheets. List the classes in consecutive numerical order and list
alongside each class the goods or services appropriate to that class.

Select target paragraph3