Mark : 
                                                                                  Reg. No./Date: 
                                                                                  Class No./Nos.: 

TO THE DIRECTOR: 

           Your Petitioner _____________________________________________________ 
________________________________________________________________________ 

a citizen/corporation of __________________________________________________________________ 
 

residing/doing business at _______________________________________________________________ 

request/s that the above-identified registration which it/he owns be renewed in accordance 
with the provision of Republic Act No. 8293. 

           Pursuant to the rules and regulations, Petitioner hereby encloses the duplicate/xerox copy of the original registrations, and the required fee. 

           Petitioner further alleges that: 

           (a) The said mark above-identified is in use in commerce in the Philippines on the goods
                recited in the registration, except that the used mark was discontinued on the 
                following goods: 
 

           (b) The right to the mark has been granted to the following: 
 

           (c) There is material/no material variation in the manner of display of the mark. 
            
           Enclosed herewith are five (5) labels showing the mark as customarily used. 

 Applicant hereby appoints _______________________________________________________________ 

of ________________________________________________________________ its/his agent or its/his attorney to file this petition, to transact business with the Intellectual Property Office in connection therewith. 

 Signed at ______________________________________________ this ____________________day of ___________________, 19 _______. 
 

  
                                                                                        _________________________ 
                                                                                        Signature, and if representing a 
                                                                                        juridical entity, the Official Title