11. Designated Contracting Parties:
Please tick the countries in which protection is sought
AF Afghanistan
AG Antigua and Barbuda
AL Albania
AM Armenia
AT Austria
AU Australia
AZ Azerbaijan
BA Bosnia and Herzegovina
BG Bulgaria
BH Bahrain
BN Brunei Darussalam
2
BQ Bonaire, Saint Eustatius
& Saba
6
BT Bhutan
BW Botswana
BX Benelux
BY Belarus
CA Canada
CH Switzerland
CN China
CO Colombia
CU Cuba
5
CW Curacao
6
CY Cyprus
CZ Czech Republic
DE Germany
DK Denmark
DZ Algeria
EE Estonia
EG Egypt
EM European Union
1
ES Spain
FI Finland
FR France
GM Gambia
GE Georgia
GH Ghana
5
GR Greece
HR Croatia
HU Hungary
ID Indonesia
IE Ireland
2
IL Israel
IN India
2
IR Iran (Islamic Republic of)
IS Iceland
IT Italy
JP Japan
5
KE Kenya
KG Kyrgyzstan
KH Cambodia
KP Democratic people’s
Republic of Korea
KR Republic of Korea
KZ Kazakhstan
LA Lao People’s
Democratic Republic
LI Liechtenstein
LR Liberia
LS Lesotho
LT Lithuania
LV Latvia
MA Morocco
MC Monaco
MD Republic of Moldova
ME Montenegro
MG Madagascar
MK North Macedonia
MN Mongolia
MW Malawi
MX Mexico
MZ Mozambique
NA Namibia
NO Norway
NZ New Zealand
2
OA African Intellectual
Property Organization
(OAPI)
3
OM Oman
PH Philippines
PL Poland
PT Portugal
RO Romania
RS Serbia
RU Russian Federation
RW Rwanda
SD Sudan
SE Sweden
SG Singapore
2
SI Slovenia
SK Slovakia
SL Sierra Leone
SM San Marino
ST Sao Tome and Principe
SX Sint Maarten (Dutch part)
6
SY Syrian Arab Republic
SZ Eswatini
TH Thailand
TJ Tajikistan
TM Turkmenistan
TN Tunisia
TR Turkey
UA Ukraine
US United States of America
4
UZ Uzbekistan
VN Viet Nam
WS Samoa
ZM Zambia
ZW Zimbabwe
Other:
1. The designation of the European Union covers the following Member States: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark,
Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, The Netherlands, Poland, Portugal,
Romania, Slovakia, Slovenia, Spain, Sweden, United Kingdom.
If the European Union is designated, it is compulsory to indicate a second language before the Office of the European Union, among the following
(check one box only): French German Italian Spanish
Moreover, if the applicant wishes to claim the seniority of an earlier mark registered in, or for, a Member State of the European Union, the official form
MM17 must be annexed to the present international application. The MM17 can be found at http://www.wipo.int/madrid/en/forms/
2. By designating Brunei Darussalam, India, Ireland, New Zealand or Singapore, the applicant declares that he has the intention that the mark will
be used by him or with his consent in that country in connection with the goods and services identified in this application.
3. The designation of the African Intellectual Property Organization covers the following Member States: Benin, Burkina Faso, Cameroon, Central
African Republic, Chad, Comoros, Congo, Côte d’Ivoire, Equatorial Guinea, Gabon, Guinea, Guinea-Bissau, Mali, Mauritania, Niger, Senegal, Togo.
4. If the United States of America is designated, it is compulsory to annex to the present international application the official form (MM18) containing
the declaration of intention to use the mark required by this Contracting Party. Section 2 (further information) of the present form should also be
completed. The MM18 can be found at http://www.wipo.int/madrid/en/forms/. We would advise you to file the MM18 with the MM2. Otherwise,
you will need to send the form directly to the International Bureau (WIPO).
5.
Cuba and Japan have made a notification under Rule 34(3)(a) of the Common Regulations. Their respective individual fees are payable in
two parts. Therefore, if Cuba or Japan is designated, only the first part of the applicable individual fee is payable at the time of filing the present
international application. The second part will have to be paid only if the Office of the Contracting Party concerned is satisfied that the mark which is the
subject of the international registration qualifies for protection. The date by which the second part must be paid, and the amount due, will be notified
to the holder of the international registration at a later stage.
6. Territorial entity previously part of the former Netherlands Antilles.