APPLICATION FOR CONVERSION OFFICE FOR HARMONIZATION IN THE INTERNAL MARKET (OHIM)

Last updated: 07/2013
OFFICE FOR HARMONIZATION IN THE INTERNAL MARKET (OHIM)
Number of pages
(including this one)
1.
Applicant/representative reference (not more than 20 characters)
2.
CTM application/registration number
No
3.
Mod.010
APPLICATION FOR CONVERSION
Verbal part of the mark (if appropriate)
Language
BG
ES
CS
DA
DE
ET
EL EN
HR
FR
IT
LV
LI
HU
MT
NL
PL
PT RO
SK
SL
FI
SV
4.
Applicant
ID number
legal entity Name of legal entity or
Legal form
of the entity
first name and surname
5.
Representative
natural person
ID number
Name for verification
Type of representative
6.
legal practitioner
OHIM representative
association of representatives
Ground for conversion
7.
Member
State(s)
Date of communication from the Office:
___ / ___ / ______
The Community trade mark application has been withdrawn
___ / ___ / ______
Date of withdrawal of application:
The Community trade mark application has been refused by a decision of the Office
___ / ___ / ______
Date of the decision:
The Community trade mark registration has ceased to have effect
as a result of a decision by the Office
___ / ___ / ______
Date of the decision:
The Community trade mark registration has been surrendered
Date of entry of the surrender in the Register: ___ / ___ / ______
The Community trade mark registration has not been renewed
___ / ___ / ______
Date of expiry of protection:
The Community trade mark registration has ceased to have effect
as a result of a decision of a Community trade mark court
Date when decision became final:
Copy of decision attached
___ / ___ / ______
Total Current account with OHIM 9.
Payment of fees
€ 200
Do not use my current account with OHIM
BG
GR
CY
PL
SE
BX
ES
LV
PT
GB
CZ
FR
MT
RO
DK
HR
LT
SI
DE
IE
HU
SK
EE
IT
AT
FI
Banco Bilbao Vizcaya Argentaria
#TM010EN
/
/
Priority / seniority
Priority was claimed for some or all the goods/ services of the CTM application
Seniority was claimed for some or all the goods/
services contained in the earlier registration
I request the OHIM to communicate relevant information
relating to the above mentioned Community trade
mark application or registration contained in its data
base to the central industrial property offices of
the specified Member States, according to Art. 113
CTMR and Rules 44 and 47 CTMIR. 10.
Signature
Signature
Transfer to account of OHIM
Date of transfer (DD/MM/YYYY)
8.
Name
Account No
La Caixa
The Community trade mark application has been deemed withdrawn
employee
Complete this page only if partial conversion is requested
APPLICATION FOR CONVERSION
List of goods and services
#TM010EN
Class No
attached
list of goods and services
ANNEX TO THE CONVERSION FORM
National representation
(before the national Office)
Country
Name
BG
BX
CZ
DK
DE
GR
ES
FR
PT
RO
SI SK
FI
SE
GB
HR
IE
IT
CY
LV
LT
HU
LT
HU
LT
HU
EE
AT
MT
EE
AT
MT
EE
AT
MT
PL Tel, fax, e-mail Address
Street and number
City and postal code
Country
Postal address
(if different)
National representation
(before the national Office)
Country
Name
BG
BX
CZ
DK
DE
GR
ES
FR
PT
RO
SI SK
FI
SE
GB
HR
IE
IT
CY
LV
PL Tel, fax, e-mail Address
Street and number
City and postal code
Country
Postal address
(if different)
National representation
(before the national Office)
Country
Name
BG
BX
CZ
DK
DE
GR
ES
FR
PT
RO
SI SK
FI
SE
GB
HR
IE
IT
CY
LV
Tel, fax, e-mail Address
Street and number
City and postal code
#TM010EN
Country
Postal address
(if different)
If the space provided is not sufficient,
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