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Trademark exclusive right pledge registration application

Name of pledgee:

Legal representative:

phone:

address:

Postal code:

Agency name:

Pledgor name:

Legal representative:

phone:

address:

Postal code:

Agency name:

Pledged trademark registration number:

Reasons for applying for pledge:

Pledge guarantee main creditor type:

Pledged Guaranteed Master Claims:

evaluation:

Pledged value:

Pledge period from: to:

Pledge of the pledgee: Placing the stamp of the pledge: the organization stamp:

Agency organization stamp: Agent signature: Agent signature:

Note:

1. If you do not entrust an agent, you do not need to fill in the agent column.

2. Madrid International Registered Trademarks shall be marked with the letter "G" before the registration number.

3. The trademark pledge is shared. The “Pledgor” column is required to fill in the name of the representative and is deemed to have been authorized by other co-owners.

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