Date of receipt (DD/MM/YYYY) …
[to be completed by the Commission]
Number of pages (including this page) …
Language of request of objection …
File number [to be completed by the Commission] …
Name of legal or natural person …
Full address (street number and name, town/city and postal code, country) …
Nationality …
Tel., fax, e-mail …
Member State(s) (*) …
Third-country authority (optional) (*) …
[(*) delete as appropriate]
Name(s) of intermediary(ies) …
Full address(es) (street number and name, town/city and postal code, country) …
Protected designation of origin (*) …
Protected geographical indication (*) …
National geographical indication (*)
[(*) delete as appropriate]
Name …
Registration number …
Date of registration (DD/MM/YYYY) …
Existing protected traditional term …
Trademark
Sign …
List of products and services …
Registration number …
Date of registration …
Country of origin …
Reputation/renown (*) …
[(*) delete as appropriate]
Article 31 (*)
Article 35 (*)
Article 40(2)(a) (*)
Article 40(2)(b) (*)
Article 40(2)(c) (*)
Article 41(3) (*)
Article 42(1) (*)
Article 42(2) (*)
Article 54 of Regulation (EC) No 479/2008
[(*) delete as appropriate]
Name of signatory …
Signature …”