ANNEX IAPPLICATION FOR REGISTRATION OF A DESIGNATION OF ORIGIN OR GEOGRAPHICAL INDICATION
Date of receipt (DD/MM/YYYY) …
[to be completed by the Commission]
Number of pages (including this page) …
Language used for submission of application …
File number …
[to be completed by the Commission]
Applicant
Name of legal or natural person …
Full address (street number and name, town/city and postal code, country) …
Legal status, size and composition (in the case of legal persons) …
Nationality …
Tel, fax, e-mail …
Intermediary
Member State(s) (*)
Third-country authority (*)
[(*) delete as appropriate]
Name(s) of intermediary(ies) …
Full address(es) (street number and name, town/city and postal code, country) …
Tel, fax, e-mail …
Name to be registered …
Designation of origin (*)
Geographical indication (*)
[(*) delete as appropriate]
Proof of protection in third country …
Categories of grapevine products …
[on separate sheet]
Product specification
Number of pages …
Name(s) of signatory(ies) …
Signature(s) …