IPOPHL Form
400
Intellectual Property Office of the Philippines
For IPOPHL use only
28 Upper McKinley Rd, Fort Bonifacio, Taguig City 1634 PH
☏ +63 (2) 7238-6300 | [email protected] Application No.
Date Received
TRADEMARK APPLICATION Date Mailed
IPSO / ITSO Code
TRADEMARK INFORMATION
Title of the Mark
Claim of Color/s
Place a copy of the
Mark inside the
Translation / Transliteration
box. It should be
clear enough for
the reproduction Disclaimer
and digitization.
Type
Word Mark Figurative Mark Figurative w/ Word Mark
Three-dimensional Collective Mark
CLAIM OF CONVENTION PRIORITY (If applicable)
Prior Foreign Application Number/s Foreign Filing Date (yyyy/mm/dd) Country
To add more priority claim/s, please use, IPOPHL Form 120 – Supplemental Priority Form
APPLICANT INFORMATION (For Individual applicants, you may skip Name of Company/Government/School and Position fields)
Type of Applicant Individual Company / Corporation School Government
Name of Company / Corporation / Government Agency / Entity
School Big (Total Assets > P100M) Small (Total Assets P100M or less)
Position Sex
OWNER Male Female
Last Name First Name Middle Name
HERNANDEEZ MON CARLOS ZERRUDO
Address (Complete street info, village, subdivision, barangay)
BLK 22 LOT 18 PHASE 1 ALLEY
Town / City Province / State Zip Code Country of Residence
Contact No. Email Address Nationality
* At least one Applicant is mandatory | The applicant with no agent or authorized representative must inform the office of any changes in the
contact information | To add more applicants, please use, IPOPHL Form 110 – Supplemental Sheet
RESIDENT AGENT / AUTHORIZED REPRESENTATIVE (If supplied, all correspondences will be sent to this contact)
Agent Number (If available) Company Name (The law firm, if applicable)
Position Sex
Male Female
Last Name First Name Middle Name
Address (Complete street info, village, subdivision, barangay)
Town / City Province / State Zip Code Country of Residence
Contact No. Email Address Nationality
Agent or authorized representative must inform the office of any changes in the contact information
GOODS AND SERVICES (Pls. refer to the list of Nice Classes on IPOPHL Form 410 – Nice Classes )
* At least one good or service is mandatory | Use additional sheet/s if necessary
IPOPHL Form 400 – Trademark Application IPOPHL is an ISO 9001:2015 QMS Certified government agency Page 1 of 2
IPOPHL Form
400
IMPORTANT REMINDERS
Pursuant to Section 124.2 and Section 145 of R.A. 8293 and the Trademark Regulations:
1.
The applicant or the registrant shall file DECLARATION OF ACTUAL USE (DAU) of the mark with evidence
to that effect, as prescribed by the Regulations within three (3) years from the filing date of application.
Otherwise, the application shall be REFUSED or the mark shall be REMOVED from the Register by the
Director.
2. A certificate of registration shall remain in force for ten (10) years; provided, that the registrant shall file a DAU
to that effect, or shall show valid reasons based on the existence of obstacles to such use, as prescribed by
the Regulations, within one (1) year from the fifth (5th) anniversary of the date of registration, otherwise, the
mark shall be REMOVED from the Register by the Office.
3. A Renewal DAU must be filed within one (1) year from the date of renewal of the registration, otherwise,
the mark shall be removed from the Register.
IPOPHL PRIVACY STATEMENT AS PER RA 10173 ALSO KNOWN AS "DATA PRIVACY ACT OF 2012" AND SIGNATURE
Agree Disagree I declare that all the information provided above
are true and correct to the best of my
By ticking the AGREE box and affixing my signature to the knowledge.
right, I understand that I am giving consent to the collection,
storage, sharing and other necessary processing of the
personal information contained in this application, freely and
voluntarily, to the Intellectual Property Office of the Philippines
(IPOPHL) and its partners, in the exercise of its mandate as
the lead government agency for the protection of IP rights
and in compliance with the provisions of RA 10173, also
known as, the Data Privacy Act of 2012. SIGNATURE OVER PRINTED NAME
NOTE: Submission of this Application Form and Payment of the Filing Fees do not mean that the mark is registered as there are stages for the whole
registration process. The mark shall be deemed registered upon completion of all the requirements under the IP Code and Trademark Regulations.
The address stated in these forms shall be used for sending notices and orders in cases filed with BLA.
IPOPHL Form 400 – Trademark Application IPOPHL is an ISO 9001:2015 QMS Certified government agency Page 2 of 2
