【正文】 25___________________________________________________________________________11. Time Period of License12 The license is limited in time and granted from .......................to ....................... . The license is subject to automatic extension. The license is granted for an unlimited period of time.___________________________________________________________________________12. Signatures or Seals13 Signature(s) or seal(s) of the holder(s)/applicant(s): Name of the holder/applicant or, if the holder/applicant is a legal entity, name of the person who acts on behalf of the holder/applicant: Date of signature or of sealing: Signature or seal: Signature(s) or seal(s) of the licensee(s):14 Name of the licensee(s) or, if the licensee(s) is a legal entity, name of the person who acts on behalf of the licensee(s): Date of signature or of sealing: Signature or seal:12 Check the appropriate box.13 If there is more than one person signing or whose seal is used, all of the indications under subitems to should be given on an additional sheet.14 The signature of the licensee is only necessary if the request is not signed by the holder/applicant. In this case, the request must be acpanied, at the option of the requesting party, by one of the following: (i) an extract of the license contract, indicating the parties and the rights being licensed, which extract may be required to be certified, by a notary public or any other petent public authority, as being a true extract of the contract。 授權(quán)僅涉及註冊所適用的如下領(lǐng)土部分：11 根據(jù)《商標(biāo)法條約》 第 4 條第(2)項(xiàng)(b)款，如果被授權(quán)人在本請求書第 1 頁指明的主管機(jī)關(guān)所屬的締約方領(lǐng)土內(nèi)沒有、或沒有說明有住所或真實(shí)有效的工商營業(yè)所，必須在第 5 款中填寫送達(dá)地址，但已在第 7 款中填寫代理人者除外。 授權(quán)是獨(dú)家授權(quán)。在此情況下，請用附頁分別就每一項(xiàng)註冊和/或申請?jiān)]明：授權(quán)是涉及全部商品和/或服務(wù)還是僅涉及部分商品和/或服務(wù)。 第 2 款僅提及一項(xiàng)註冊或申請，僅授權(quán)在該註冊或申請中列出的部分商品和/或服務(wù)上使用。10 委任書沒有序號或尚未指定序號的，或被授權(quán)人或其代理人不知悉委任書序號的，可不填此欄。9 即使主管機(jī)關(guān)要求提供此一資料，被授權(quán)人或其代理人亦可選擇不填。7. 被授權(quán)人的代理人 姓名： 地址 (包括郵遞區(qū)號和國家 ):電話號碼： 9 傳真號碼： 9 已向主管機(jī)關(guān)註冊，其註冊號： 委任書被指定的序號： 10___________________________________________________________________________8 即使主管機(jī)關(guān)要求提供此一資料，被授權(quán)人或其代理人亦可選擇不填。21___________________________________________________________________________ Address (including postal code and country): Telephone number(s):8 Telefacsimile numbers(s):8 State of nationality of the licensee: State of domicile of the licensee: State of real and effective industrial or mercial establishment of the licensee: Check this box if there is more than one licensee。6 委任書沒有序號或尚未指定序號的，或註冊持有人 /申請人或其代理人不知悉委任書序號的，可不填此欄。18___________________________________________________________________________4. Representative of Holder(s)/Applicant(s) Name: Address (including postal code and country):Telephone number(s):5 Telefacsimile number(s):5 Registration number, if registered with the Office: Number allotted to the power of attorney:6___________________________________________________________________________5. Address for Service of Holder(s)/Applicant(s)7___________________________________________________________________________6. Licensee If the licensee is a natural person, the person’s (a) family or principal name: (b) given or secondary name(s): If the licensee is a legal entity,(a) the entity’s full official designation:(b) the legal nature of the legal entity:(c) the State, and, where applicable, the territorial unit within that State, under the law 5 Even where the Office elects to request this information, the holder/applicant or his representative has the option to refrain from providing such indications. Where they are given, they should include the country code (where appropriate) and area code.6 Leave blank if the power of attorney has not, or has not yet, been allotted a number or if the number is not known to the holder/applicant or the representative.7 According to Article 4(2)(b) of the TLT, an address for service must be indicated in the space available under the title of item 5 where the holder/applicant does not have, or has not indicated, a domicile or a real and effective industrial or mercial establishment on the territory of the Contracting Party whose Office is the Office named on the first page of the present request, except where a representative is indicated in item 4.19of which the legal entity is anized:20___________________________________________________________________________4. 註冊持有人/申請人的代理人 姓名： 地址 (包括郵遞區(qū)號和國家 )：電話號碼： 5 傳真號碼： 5 若已向主管機(jī)關(guān)註冊，註冊號： 委任書被指定的序號： 6___________________________________________________________________________5. 註冊持有人/申請人的送達(dá)地址 76. 被授權(quán)人 被授權(quán)人是自然人的，請?zhí)钤撊说?a) 姓氏：(b) 名字： 被授權(quán)人是法人的，請?zhí)?a) 該法人的正式全稱：(b) 該法人的法律性質(zhì)： (c) 該法人係依那一國以及在可適用的情況下該國的那一領(lǐng)土區(qū)域的法律所組成的：5 即使主管機(jī)關(guān)要求提供此一資料，註冊持有人 /申請人或其代理人亦可選擇不填。4 即使主管機(jī)關(guān)要求提供此一資料，註冊持有人 /申請人或其代理人亦可選擇不填。____________________________________________________________________________3. 註冊持有人/申請人 註冊持有人/申請人若為自然人，請?zhí)钤撟匀蝗说?a) 姓氏： 3(b) 名字： 3 註冊持有人/申請人若為法人，請?zhí)?a) 該法人的正式全名：(b) 該法人的法律性質(zhì)：(c)該法人係依那一國以及在可適用的情況下該國的那一領(lǐng)土區(qū)域的法律所組成的： 地址(包括郵遞區(qū)號和國家)： 電話號碼： 4 傳真號碼： 4 註冊持有人/ 申請人不只一人時(shí)，請?jiān)诖烁駜?nèi)作標(biāo)記；在此情況下，請用附頁將其他持有人/申請人一一列出，並註明每一註冊持有人/申請人的第 或 款和第 款所指的資料。僅供主管機(jī)關(guān)填寫註冊持有人/申請人和/ 或被授權(quán)人的參考說明： 1 ................註冊持有人/申請人之 代理人的參考說明： ...............被授權(quán)人代理人的參考說明： 1 . ..............16___________________________________________________________________________2. Registration(s) and/or Application(s) ConcernedThe present request concerns the following registration(s) and/or application(s): Registration and/or application number(s): If the space under item is not sufficient, check this box and provide the information on an additional sheet.___________________________________________________________________________3. Holder(s)/Applicant(s) If the holder/applicant is a natural person, the person’s(a) family or principal name:3(b) given or secondary