IN THE HOLDER’S CONTACT INFORMATION. (optional) If no change is requested below, the International Bureau will maintain the holder’s current contact information, if any Delete the holder’s address for correspondence or update it with the information that appears below New address for correspondence: Delete the holder’s phone and fax numbers or update them with the information that appears below New telephone: New fax: Delete the holder’s e-mail address or update it with the information that appears below New e-mail address: By providing an e-mail address, any further correspondence from the International Bureau related to this/these international registration(s) will be sent only electronically and, therefore, you will no longer receive any paper correspondence. Likewise, any further correspondence from the International Bureau related to other international applications or international registrations for which the same e-mail address has been, or will be, provided will also be sent only electronically. Please note that, for the purpose of electronic communication, there can be only one e-mail address recorded per each international registration.
IN THE HOLDER’S CONTACT INFORMATION. (optional) If no change is requested below, the International Bureau will maintain the holder’s current contact information, if any Delete the holder’s address for correspondence or update it with the information that appears below New address for correspondence: Delete the holder’s phone and fax numbers or update them with the information that appears below New telephone: New fax: Delete the holder’s e-mail address or update it with the information that appears below New e-mail address: By providing an e-mail address, any further correspondence from the International Bureau related to this/these international registration(s) will be sent only electronically and, therefore, you will no longer receive any paper correspondence. Likewise, any further correspondence from the International Bureau related to other international applications or international registrations for which the same e‑mail address has been, or will be, provided will also be sent only electronically. Please note that, for the purpose of electronic communication, there can be only one e-mail address recorded per each international registration. APPOINTMENT OF A (NEW) REPRESENTATIVE (optional) (only complete this item if you are appointing a (new) representative) Name: Address: Telephone: Fax: E-mail address: By providing an e-mail address, any further correspondence from the International Bureau related to this/these international registration(s) will be sent only electronically and, therefore, you will no longer receive any paper correspondence. Likewise, any further correspondence from the International Bureau related to other international applications or international registrations for which the same e‑mail address has been, or will be, provided will also be sent only electronically. Please note that, for the purpose of electronic communication, there can be only one e-mail address recorded per each international registration. SIGNATURE OF THE HOLDER APPOINTING THE ABOVE (NEW) REPRESENTATIVE 6 7 SIGNATURE BY THE HOLDER AND/OR HIS REPRESENTATIVE Holder Representative of the holder (as recorded in the International Register) (as recorded in the International Register or herein appointed) By signing this form, I declare that I am entitled to By signing this form, I declare that I am entitled to sign it under the applicable law: sign it under the applicable law: Name: Name: Signature: Signature: OFFICE OF THE CONTRACTING PARTY OF THE HOLDER PRESENTING THE REQUEST (where this request is pres...
