ANNEX IXREQUEST OF CANCELLATION CONCERNING A TRADITIONAL TERM

Date of receipt (DD/MM/YYYY) …

[to be completed by the Commission]

Number of pages (including this page) …

Author of the request of cancellation …

File number …

[to be completed by the Commission]

Language of request of cancellation

Name of legal or natural person …

Full address (street number and name, town/city and postal code, country)

Nationality …

Tel, fax, e-mail …

Contested traditional term

Legitimate interest of the author of the request

Declaration by the Member State or third country