Information on the merchandise suspected of being counterfeit or pirated:
- Nature of the merchandise:
- Commercial designation:
- Origin: 3
- From:3
- Distinctive elements making it possible to identify the merchandise suspected of
being counterfeit or pirated: 4
- Country of production:3
- Name and address of manufacturer:3
- Other useful information:3
- Quantity
Attachments:
- Undertaking:
- Other documents:
Done at
,
(Stamp and signature)
3
4
If such information is available.
Attach documents, such as catalogs, photos, brochures.
8