BRAND REGISTRATION APPLICATION FORM

Page

* Application date: * For brand registration :
* Number of agenda: * Application acceptance date :

Name, Citizenship, and Address :

Brand Owner :


Name and Address of Authority :


Chosen Address in Indonesia :
(If the brand owner does not reside in Indonesia)


Name of Country and Date of First Brand
Registration Application:
(Filled if the registration application is
accompanied by priority rights).



E-ticket colors:

Brand E-ticket:
The meaning of foreign
language/letters/numbers in the brand e-ticket:







Item/Service Class:
Item/Service Classification:





*Filled by the Brand Office

(name of place), (date/time)

Materai 6000


(................................................)
(BRAND OWNER/AUTHORITY)






















STATEMENT LETTER



The undersigned:

Name :

Address :


Hereby states that our brand BRANDDOE that is mentioned in our application letter is genuinely ours. There is no
fringing of other parties copyrights or products in any other forms or methods.


(name of place), (date and time)


Brand Owner,
Materai 6000

(.................................)
DIRECTOR





















Dwi Putra Rahardjo T
Pinang Perak 1/3 RT.0113/016, Pondok Pinang
Kebayoran Lama jakarta Selatan











STATEMENT LETTER OF CREATION



The undersigned:

Name :

Address :


Hereby states that I am the holder of the copyright of the logo: ...........................................................................
that will be registered at Direktorat Hak Cipta, DI, DTLST, and RD, Direktorat Jenderal Hak Kekayaan Intelektual.

In the future, if there is sufficient evidence that other parties are the real holder or creator before me, I am willing
to cancel the registration of this afromentioned creation of art.



Brand Owner,


(.................................)

DIRECTOR