我/我公司 I/We,

是 國籍/依 a citizen of/a corporation organized and existing

國家/地區法律組成。現委托 under the laws of

北京方氏卓越知識產權代理有限公司 , hereby entrust

在中華人民共和國代理 FANG’S ZHUOYUE INTELLECTUAL PROPERTY AGENCY

商標在第 類的在如下事宜： to act as my/our agent in P.R. China for:

□ 商標注冊申請 □ registration

□ 商標異議申請 □ opposition

□ 變更商標申請人/注冊人名義/地址申請 □ change of name/address of applicant/registrant

□ 刪減商品/服務項目申請 □ deletion of goods/services

□ 變更商標代理人申請 □ change of trademark agent

□ 更正商標申請/注冊事項申請 □ modification of application/registration

□ 轉讓申請/注冊商標申請 □ assignment of application/registration

□ 商標續展注冊申請 □ renewal of registration

□ 撤銷連續三年停止使用注冊商標申請 □ cancellation against 3 year non-use registration

□ 商標注銷申請 □ removal of registration

□ 注冊人死亡/終止注銷商標申請 □ removal of registration of dead registrant

□ 補發變更/轉讓/續展證明申請 □ reissuance of modification/assignment/renewal certificate

□ 補發商標注冊證申請 □ reissuance of registration certificate

□ 提供商標注冊證明申請 □obtaining trademark registration certificate

□ 提供優先權證明文件申請 □ obtaining convention priority documents

□ 商標使用許可合同備案申請 □ recordal of trademark license contract

□ 商標使用許可合同備案變更/提前終止申請 □ change/termination of trademark license

□ 商標專用權質押登記申請 □ recordal of trademark mortgage

□ 撤回商標注冊申請申請 □ withdrawal of application

□ 撤回商標異議申請 □ withdrawal of opposition

□ 商標評審事宜 □ trademark review and adjudication

□ 其他 □ other matters

in relation to the trademark

in Class .

委 托 人： Name:

地 址： Address:

簽 章： Signature:

日 期： 年 月 日 Date: , 20