# L_2007261EN.01001201.xml

| 6.10.2007 | EN | Official Journal of the European Union | L 261/12 |
| --- | --- | --- | --- |

6.10.2007

EN

Official Journal of the European Union

L 261/12

---

COMMISSION REGULATION (EC) No 1172/2007

of 5 October 2007

amending Commission Regulation (EC) No 1891/2004 of 21 October 2004 laying down provisions for the implementation of Council Regulation (EC) No 1383/2003 concerning customs action against goods suspected of infringing certain intellectual property rights and the measures to be taken against goods found to have infringed such rights

THE COMMISSION OF THE EUROPEAN COMMUNITIES,

Having regard to the Treaty establishing the European Community,

Having regard to Council Regulation (EC) No 1383/2003 of 22 July 2003 concerning customs action against goods suspected of infringing certain intellectual property rights and the measures to be taken against goods found to have infringed such rights (1), and in particular Article 20 thereof,

Whereas:

| (1) | Regulation (EC) No 1383/2003 provides for action by the customs authorities in respect of goods suspected of infringing certain intellectual property rights. |
| --- | --- |

(1)

Regulation (EC) No 1383/2003 provides for action by the customs authorities in respect of goods suspected of infringing certain intellectual property rights.

| (2) | Commission Regulation (EC) No 1891/2004 (2) lays down provisions for the implementation of Regulation (EC) No 1383/2003, in particular as regards the application for action forms. Annexes I and II to that Regulation contain the models showing the required format of such application forms. |
| --- | --- |

(2)

Commission Regulation (EC) No 1891/2004 (2) lays down provisions for the implementation of Regulation (EC) No 1383/2003, in particular as regards the application for action forms. Annexes I and II to that Regulation contain the models showing the required format of such application forms.

| (3) | Annexes I-C and II-C to Regulation (EC) No 1891/2004 contain the list of competent authorities to which applications for national and Community action respectively must be submitted. Article 8 of the Regulation provides that the Commission must publish the list of departments within the customs authority, as referred to in Article 5(2) of Regulation (EC) No 1383/2003, in the C series of the Official Journal of the European Union. As the lists in Annexes I-C and II-C contain information that is subject to change and needs to be regularly updated, it is more appropriate to publish them in the C series of the Official Journal of the European Union. Annexes I-C and II-C to Regulation (EC) No 1891/2004 should therefore be deleted. |
| --- | --- |

(3)

Annexes I-C and II-C to Regulation (EC) No 1891/2004 contain the list of competent authorities to which applications for national and Community action respectively must be submitted. Article 8 of the Regulation provides that the Commission must publish the list of departments within the customs authority, as referred to in Article 5(2) of Regulation (EC) No 1383/2003, in the C series of the Official Journal of the European Union. As the lists in Annexes I-C and II-C contain information that is subject to change and needs to be regularly updated, it is more appropriate to publish them in the C series of the Official Journal of the European Union. Annexes I-C and II-C to Regulation (EC) No 1891/2004 should therefore be deleted.

| (4) | On 1 January 2007 Bulgaria and Romania acceded to the European Union. Regulation (EC) No 1891/2004 should therefore be adapted to include reference to these countries in the Community application for action form which it contains. |
| --- | --- |

(4)

On 1 January 2007 Bulgaria and Romania acceded to the European Union. Regulation (EC) No 1891/2004 should therefore be adapted to include reference to these countries in the Community application for action form which it contains.

| (5) | The Community application for action form should have been adapted by Commission Regulation (EC) No 1792/2006 of 23 October 2006 adapting certain regulations and decisions in the fields of free movement of goods, freedom of movement of persons, competition policy, agriculture (veterinary and phytosanitary legislation), fisheries, transport policy, taxation, statistics, social policy and employment, environment, customs union and external relations by reason of the accession of Bulgaria and Romania (3), which entered into force on the date of the entry into force of the Treaty of Accession of these countries. |
| --- | --- |

(5)

The Community application for action form should have been adapted by Commission Regulation (EC) No 1792/2006 of 23 October 2006 adapting certain regulations and decisions in the fields of free movement of goods, freedom of movement of persons, competition policy, agriculture (veterinary and phytosanitary legislation), fisheries, transport policy, taxation, statistics, social policy and employment, environment, customs union and external relations by reason of the accession of Bulgaria and Romania (3), which entered into force on the date of the entry into force of the Treaty of Accession of these countries.

| (6) | In the interests of consistency, the Community application for action form should be adapted from the date of accession of Bulgaria and Romania. |
| --- | --- |

(6)

In the interests of consistency, the Community application for action form should be adapted from the date of accession of Bulgaria and Romania.

| (7) | Regulation (EC) No 1891/2004 should therefore be amended accordingly. |
| --- | --- |

(7)

Regulation (EC) No 1891/2004 should therefore be amended accordingly.

| (8) | The measures provided for in this Regulation are in accordance with the opinion of the Customs Code Committee, |
| --- | --- |

(8)

The measures provided for in this Regulation are in accordance with the opinion of the Customs Code Committee,

HAS ADOPTED THIS REGULATION:

Article 1

Regulation (EC) No 1891/2004 is hereby amended as follows:

| 1. | In Annex I, in box 2 of the national application for action (AA) form, the words ‘(see Annex l-C for details)’ are deleted. |
| --- | --- |

1.

In Annex I, in box 2 of the national application for action (AA) form, the words ‘(see Annex l-C for details)’ are deleted.

| 2. | Annex I-C is deleted. |
| --- | --- |

2.

Annex I-C is deleted.

| 3. | Annex II is replaced by the text in the Annex to this Regulation. |
| --- | --- |

3.

Annex II is replaced by the text in the Annex to this Regulation.

| 4. | In Annex IIA, in the final sentence, the words ‘listed in Annex II-C’ are deleted. |
| --- | --- |

4.

In Annex IIA, in the final sentence, the words ‘listed in Annex II-C’ are deleted.

| 5. | Annex II-C is deleted. |
| --- | --- |

5.

Annex II-C is deleted.

Article 2

This Regulation shall enter into force on the day of its publication in the Official Journal of the European Union.

However, Article 1(3) shall apply from 1 January 2007.

This Regulation shall be binding in its entirety and directly applicable in all Member States.

Done at Brussels, 5 October 2007.

For the Commission

László KOVÁCS

Member of the Commission

---

(1)  
  OJ L 196, 2.8.2003, p. 7.

1

(2)  
  OJ L 328, 30.10.2004, p. 16.

2

(3)  
  OJ L 362, 20.12.2006, p. 1.

3

---

ANNEX

‘ANNEX II

Image 1

COMMUNITY APPLICATION FOR ACTION

1. Date of receipt of the application for action by the designated customs department (within the meaning of Article 5(2) of the Regulation (EC) No 1383/2003)

DD/MM/YY: ... /.../...

INTELLECTUAL PROPERTY RIGHTS

APPLICATION FOR ACTION BY CUSTOMS AUTHORITIES

under Article 5(4) of Regulation (EC) No 1383/2003

3. Details of applicant (i.e. right-holder within meaning of Article 2(2) of Regulation (EC) No 1383/2003) (*):

NAME:

FUNCTION:

ADDRESS:

TOWN:

POSTCODE:

COUNTRY:

VAT No:

TEL.:

MOBILE:

FAX:

E-MAIL:

INTERNET ADDRESS:

2. Name and address of competent authority to which application is made:

4. Status of applicant (within the meaning of Article 2(2) of Regulation (EC) No 1383/2003) (1):

Right-holder (*)

Right-holder’s representative (*)

Authorised user of the right (*)

Representative of authorised user (*)

5. Type of right to which application refers:

Community trademark (2)

Community design right (3)

Supplementary protection certificate (4)

Geographical indication protected by the Community (5)

Designation of origin protected by the Community (5)

Community protected plant variety right (6)

Geographical designations for spirit drinks (7)

6. Member State(s) in which action by customs authorities is requested:

BE

EE

IT

HU

PT

SE

BG

IE

CY

MT

RO

UK

CZ

EL

LV

NL

SI

DK

ES

LT

AT

SK

DE

FR

LU

PL

FI

7. I attach essential technical data on the authentic goods:

Number of documents attached (8)

Number of photos attached (8)

8. I attach specific information concerning the type or pattern of fraud:

Number of documents attached (8)

Number of photos attached (8)

COPY FOR THE MEMBER STATE

Image 2

9. I attach document(s) attesting to the fact that the applicant holds the right for the goods in question within the meaning of Article 2(2) of Regulation (EC) No 1383/2003 (*):

Number of documents attached (8)

10. I attach the undertaking laid down in Article 6 of Regulation (EC) No 1383/2003, assuming liability in the situations outlined in that Article (*):

Undertaking attached:

11. Right-holder’s contact person in the other Member States where action is requested (1):

ADMINISTRATIVE QUESTIONS (lawyer, for example)

BE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

BG

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

CZ

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

DK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

DE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

EE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

IE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

EL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

ES

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

FR

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

IT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

CY

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

LV

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

LT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

LU

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

HU

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

MT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

NL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

AT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

PL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

Image 3

PT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

RO

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SI

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

FI

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

UK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

12. Right-holder’s contact person in the other Member States where action is requested (1):

TECHNICAL QUESTIONS (expert, for example)

BE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

BG

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

CZ

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

DK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

DE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

EE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

IE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

EL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

ES

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

FR

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

IT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

CY

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

Image 4

LV

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

LT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

LU

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

HU

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

MT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

NL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

AT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

PL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

PT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

RO

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SI

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

FI

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

UK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

13. Any other information in the right-holder’s possession, e.g.:

Country or countries of production

Number of documents attached (8)

Routes used by traffickers

Number of documents attached (8)

Technical differences between the authentic and the suspect goods

Number of documents attached (8)

CN tariff heading

Other useful information

Number of documents attached (8)

14. Date of filing application:

Date on which drawn up

Place

Applicant’s signature (**)

DD/MM/YY: .../.../...

Image 5

15. Decision by customs authorities (within the meaning of Article 5(7) and (8) of Regulation (EC) No 1383/2003):

The application is approved

Registration number of AA:

Date

DD/MM/YY

Place

Signature and stamp

The application is valid until: .../.../... Any request for extension of the validity period should be sent to the competent authority of Box 2, at the latest 30 working days before the validity of the application expires.

The application has been refused

A reasoned decision stating the grounds for refusal and information concerning the appeal procedure are attached.

Date

DD/MM/YY

Place

Signature and stamp

16. Acknowledgement of receipt:

Concerning application made by (name of the applicant)

BE BG CZ DK DE

EE IE EL ES FR

IT CY LV LT LU

HU MT NL AT PL

PT RO SI SK FI

SE UK

NAME:

PLACE AND DATE OF RECEIPT:

SIGNATURE AND STAMP:

(*) See box 9 (for further information see “Notes on completion”, Annex II-A).

(**) If the applicant is a representative of the right-holder, he must provide proof that he is empowered to represent the right-holder.

(1) Tick the appropriate box(es).

(2) Council Regulation (EC) No 40/94 (OJ L 11, 14.11.1994, p. 1).

(3) Council Regulation (EC) No 6/2002 (OJ L 3, 5.1.2002, p. 1).

(4) Council Regulation (EEC) No 1768/92 or Regulation (EC) No 1610/96 of the European Parliament and of the Council (OJ L 198, 8.8.1996, p. 30).

(5) Council Regulation (EEC) No 2081/92 and (EC) No 1493/99 (OJ L 179, 14.7.1999, p. 1).

(6) Council Regulation (EC) No 2100/94 (OJ L 227, 1.9.1994, p. 1).

(7) Council Regulation (EEC) No 1576/89 (OJ L 160, 12.6.1989, p. 1).

(8) Insert the relevant number; if none are attached, insert 0.

Image 6

COMMUNITY APPLICATION FOR ACTION

1. Date of receipt of the application for action by the designated customs department (within the meaning of Article 5(2) of the Regulation (EC) No 1383/2003)

DD/MM/YY: ... /.../...

INTELLECTUAL PROPERTY RIGHTS

APPLICATION FOR ACTION BY CUSTOMS AUTHORITIES

under Article 5(4) of Regulation (EC) No 1383/2003

3. Details of applicant (i.e. right-holder within meaning of Article 2(2) of Regulation (EC) No 1383/2003) (*):

NAME:

FUNCTION:

ADDRESS:

TOWN:

POSTCODE:

COUNTRY:

VAT No:

TEL.:

MOBILE:

FAX:

E-MAIL:

INTERNET ADDRESS:

2. Name and address of competent authority to which application is made:

4. Status of applicant (within the meaning of Article 2(2) of Regulation (EC) No 1383/2003) (1):

Right-holder (*)

Right-holder's representative (*)

Authorised user of the right (*)

Representative of authorised user (*)

5. Type of right to which application refers:

Community trademark (2)

Community design right (3)

Supplementary protection certificate (4)

Geographical indication protected by the Community (5)

Designation of origin protected by the Community (5)

Community protected plant variety right (6)

Geographical designations for spirit drinks (7)

6. Member State(s) in which action by customs authorities is requested:

BE

EE

IT

HU

PT

SE

BG

IE

CY

MT

RO

UK

CZ

EL

LV

NL

SI

DK

ES

LT

AT

SK

DE

FR

LU

PL

FI

7. I attach essential technical data on the authentic goods:

Number of documents attached (8)

Number of photos attached (8)

8. I attach specific information concerning the type or pattern of fraud:

Number of documents attached (8)

Number of photos attached (8)

COPY FOR THE RIGHT HOLDER

Image 7

9. I attach document(s) attesting to the fact that the applicant holds the right for the goods in question within the meaning of Article 2(2) of Regulation (EC) No 1383/2003 (*):

Number of documents attached (8)

10. I attach the undertaking laid down in Article 6 of Regulation (EC) No 1383/2003, assuming liability in the situations outlined in that Article (*):

Undertaking attached:

11. Right-holder's contact person in the other Member States where action is requested (1):

ADMINISTRATIVE QUESTIONS (lawyer, for example)

BE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

BG

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

CZ

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

DK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

DE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

EE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

IE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

EL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

ES

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

FR

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

IT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

CY

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

LV

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

LT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

LU

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

HU

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

MT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

NL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

AT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

PL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

Image 8

PT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

RO

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SI

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

FI

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

UK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

12. Right-holder’s contact person in the other Member States where action is requested (1):

TECHNICAL QUESTIONS (expert, for example)

BE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

BG

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

CZ

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

DK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

DE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

EE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

IE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

EL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

ES

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

FR

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

IT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

CY

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

Image 9

LV

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

LT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

LU

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

HU

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

MT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

NL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

AT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

PL

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

PT

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

RO

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SI

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

FI

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

SE

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

UK

Name:

Address:

Tel.:

Mobile:

Fax:

E-mail:

See attached list

13. Any other information in the right-holder’s possession, e.g.:

Country or countries of production

Number of documents attached (8)

Routes used by traffickers

Number of documents attached (8)

Technical differences between the authentic and the suspect goods

Number of documents attached (8)

CN tariff heading

Other useful information

Number of documents attached (8)

14. Date of filing application:

Date on which drawn up

Place

Applicant's signature (**)

DD/MM/YY: .../.../...

Image 10

15. Decision by customs authorities (within the meaning of Article 5(7) and (8) of Regulation (EC) No 1383/2003):

The application is approved

Registration number of AA:

Date

DD/MM/YY

Place

Signature and stamp

The application is valid until: .../.../... Any request for extension of the validity period should be sent to the competent authority of Box 2, at the latest 30 working days before the validity of the application expires.

The application has been refused

A reasoned decision stating the grounds for refusal and information concerning the appeal procedure are attached.

Date

DD/MM/YY

Place

Signature and stamp

16. Acknowledgement of receipt:

Concerning application made by (name of the applicant)

BE BG CZ DK DE

EE IE EL ES FR

IT CY LV LT LU

HU MT NL AT PL

PT RO SI SK FI

SE UK

NAME:

PLACE AND DATE OF RECEIPT:

SIGNATURE AND STAMP:

(*) See box 9 (for further information see “Notes on completion”, Annex II-A).

(**) If the applicant is a representative of the right-holder, he must provide proof that he is empowered to represent the right-holder.

(1) Tick the appropriate box(es).

(2) Council Regulation (EC) No 40/94 (OJ L 11, 14.11.1994, p. 1).

(3) Council Regulation (EC) No 6/2002 (OJ L 3, 5.1.2002, p. 1).

(4) Council Regulation (EEC) No 1768/92 or Regulation (EC) No 1610/96 of the European Parliament and of the Council (OJ L 198, 8.8.1996, p. 30).

(5) Council Regulation (EEC) No 2081/92 and (EC) No 1493/99 (OJ L 179, 14.7.1999, p. 1).

(6) Council Regulation (EC) No 2100/94 (OJ L 227, 1.9.1994, p. 1).

(7) Council Regulation (EEC) No 1576/89 (OJ L 160, 12.6.1989, p. 1).

(8) Insert the relevant number; if none are attached, insert 0.’

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