Form TMe-001 FORMULIR PERMOHONAN PENDAFTARAN MEREK INDONESIA APPLICATION FORM OF TRADEMARK REGISTRATION OF INDONESIA Data Permohonan (Application) Nomor e-Filing Number of e-Filing : WFT2017XXXXXX Tanggal Permohonan Date of Submission : 2017-12-01 Nomor Permohonan Number of Application : DI D / J I D 2 0 1 7 X X X X X X Jenis Permohonan Type of Application : Merek Dagang Non UMKM Rincian Merek (Description of Mark) Nama Merek Name of Mark : HANYA CONTOH BELAKA Etiket Gambar Image of Mark Arti Meaning : Hanya Sebuah Penamaan Warna Colors : Merah, Putih, Biru, Hitam, Abu-abu Diclaimer Disclaimer : - Pemohon (Applicant) Nama (Name) Alamat (Address) Surel/Telp. (Email/Phone) Nama / Badan Hukum Jl. xxxx Kuasa/Konsultan KI (Representative/IP Consultant) Nama (Name) Alamat (Address) Surel/Telp. (Email/Phone) Nama Konsultan HKI Jl. xxxx Kelas Barang/Jasa (Classs of Goods / Services) Kode (Class) Jenis Barang/Jasa (Description of Goods/Services) 1 s/d 45 Jenis barang 1; Jenis barang 2; dst Data Prioritas (Priority Data) Negara (Country) Nomor (Number) Tanggal (Date) Lampiran (Attachments) Salinan Sah Akta Pendirian Badan Hukum Surat Kuasa Surat Pernyataan Kepemilikan Fotokopi KTP Jakarta, 2017-12-01 Pemohon / Kuasa Applicant / Representative Tanda tangan / Signature Nama lengkap / Full Name Nama Konsultan HKI Dibubuhi Tanda Tangan Digital Oleh Direktorat Jenderal Kekayaan Intelektual (DJKI) pada tanggal tsb. <
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Form TMe-001
FORMULIR PERMOHONAN PENDAFTARAN MEREK INDONESIAAPPLICATION FORM OF TRADEMARK REGISTRATION OF INDONESIA
Data Permohonan (Application)
Nomor e-FilingNumber of e-Filing
: WFT2017XXXXXX Tanggal PermohonanDate of Submission
: 2017-12-01
Nomor PermohonanNumber of Application
: D I D / J I D 2 0 1 7 X X X X X X Jenis PermohonanType of Application
: Merek Dagang Non UMKM
Rincian Merek (Description of Mark)Nama MerekName of Mark
: HANYA CONTOH BELAKA Etiket GambarImage of Mark
ArtiMeaning
: Hanya Sebuah Penamaan
WarnaColors
: Merah, Putih, Biru, Hitam, Abu-abu
DiclaimerDisclaimer
: -
Pemohon (Applicant)
Nama (Name) Alamat (Address) Surel/Telp. (Email/Phone)
Nama / Badan Hukum Jl. xxxx
Kuasa/Konsultan KI (Representative/IP Consultant)
Nama (Name) Alamat (Address) Surel/Telp. (Email/Phone)
Nama Konsultan HKI Jl. xxxx
Kelas Barang/Jasa (Classs of Goods / Services)Kode (Class) Jenis Barang/Jasa (Description of Goods/Services)
1 s/d 45 Jenis barang 1; Jenis barang 2; dst
Data Prioritas (Priority Data)
Negara (Country) Nomor (Number) Tanggal (Date)
Lampiran (Attachments)Salinan Sah Akta Pendirian Badan HukumSurat KuasaSurat Pernyataan KepemilikanFotokopi KTP
Jakarta, 2017-12-01 Pemohon / Kuasa Applicant / Representative
Tanda tangan / SignatureNama lengkap / Full Name Nama Konsultan HKI
Dibubuhi Tanda Tangan Digital Oleh Direktorat Jenderal Kekayaan Intelektual (DJKI) pada tanggal tsb.<
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