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 PHILIPPINE INTELLECTUAL PROPERTY BRIEF
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APPLICATION FORM FOR REGISTRATION OF
TRADEMARK
 
 
 
(1) Title of the Mark____________________________ 
________________________________________________ 
(If a verbal TM, indicate this in upper letters above). 
If a pictorial TM or a verbal plus a Pictorial TM, affix an illustration of the TM within this space
(FOR IPO USE ONLY)

Application No.           : 
Filing Date                   : 
Claimed Priority Date : 
Country of Origin        :

 
   
(2) Name and address of Applicant/s (3) Citizenship or State of Incorporation
(4) Address of real and effective business establishment
(5) Name of representative, if any and address
(6) Goods or Services (7) Class/es, if known
(8) Manner of using the Mark (9) Based on Foreign Reg. 
          a) Reg. No. ___________________________ 
          b) Date: _____________________________
(10) Claim of Priority, if any. 
(a)  State where earlier               (b) Name of Office where        (c) Date of Application         (d) Application No., If available  
      application was filed                   application was filed  
      ___________________       ___________________       ______________________       _____________________ 
      ___________________       ___________________       ______________________       _____________________ 
      ___________________       ___________________       ______________________       _____________________ 
     ___________________       ___________________       ______________________       _____________________
(11) Translation or Transliteration, if any.
(12) Disclaimer, if any.
(13) Specific Description of Mark, Design, Device or Logo
(14)  Is the Mark Three-Dimensional (15) Claim of color/s, if any.
 
(16)  
__________________________________________________ 
Printed Name of Applicant/s or Representative & Signature 
_____________________ 
Official Title/Capacity 
(17) Checklist of Annex/es Number of Pages 
[ ] Additional list of goods        ______________ 
[ ] Claim of Priority                   ______________ 
[ ] Home of Applications          ______________ 
[ ] Disclaimer                           ______________ 
[ ] Claim of Color/s                  ______________ 
[ ] Translation/Transliteration  ______________
IPO-BT FORM 1
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