WIPO Registration Form

WIPO REGISTRATION FORM

This WIPO Registration Form is entered into on this date by and between Registrant Name: of Registrant Organization: , with principal address: (hereinafter "Registrant"), and Representative Name: of Representative Organization: , with principal address: (hereinafter "Representative"). The Registrant and Representative are collectively referred to as the "Parties."

RECITALS

WHEREAS, the Registrant is the owner or authorized agent of one or more intellectual property subject matters described herein and seeks registration or recordal of such subject matter through the World Intellectual Property Organization (WIPO) filing channels; and

WHEREAS, the Representative is engaged to prepare, file and prosecute applications, claims or recordals on behalf of the Registrant and to act as authorized correspondent for matters filed under WIPO-administered procedures; and

WHEREAS, the Parties wish to document the Registrant's instructions, the Representative's authority, and the terms under which the Representative will act in connection with the registration described below.

NOW, THEREFORE

In consideration of the mutual covenants set forth herein, the Parties agree as follows:

1. DEFINITIONS

For the purposes of this Form, the following definitions apply: "Registration" means the filing, recordal, prosecution or maintenance of any application, document or certificate with WIPO or any WIPO-administered system. "Materials" means any documents, drawings, deposit materials, electronic files, declarations, assignments, or other information submitted in connection with a Registration.

2. REGISTRATION DETAILS

Title of Work / Mark / Invention:

Type of Intellectual Property (check all that apply): Patent Trademark Industrial Design Copyright Other

Date of Creation or Priority Date (if applicable): Priority Claim: If checked, provide priority country and application number:

3. REPRESENTATIONS AND WARRANTIES

The Registrant represents and warrants that: (a) it is the sole owner of, or is duly authorized to act on behalf of the owner of, the subject matter described in Section 2; (b) all information and Materials supplied to the Representative are true, complete and accurate to the best of Registrant's knowledge; (c) no Materials submitted infringe or misappropriate any third-party rights; and (d) Registrant will promptly notify Representative of any fact or circumstance that may affect Registrant's authority to seek Registration.

4. AUTHORIZATION TO SUBMIT, PROSECUTE AND CORRESPOND

The Registrant hereby appoints Representative as its agent and attorney-in-fact, with authority to prepare, sign, file, amend, prosecute, withdraw and maintain applications and other documents with WIPO, to receive correspondence and documents, and to take such steps as Representative deems reasonably necessary to obtain or maintain Registration, including payment of official fees on Registrant's behalf where authorized in writing by the Registrant.

Representative shall act in accordance with Registrant's written instructions. Representative will exercise reasonable professional skill and care consistent with prevailing practice for matters of similar complexity.

5. FEES, COSTS AND PAYMENT

Registrant agrees to pay Representative's fees and all official fees, surcharge, translation and handling costs incurred in connection with the Registration. Estimated representative professional fees:

Unless otherwise agreed in writing, Representative may request and accept payment from Registrant in advance of taking action, and Registrant shall reimburse Representative for any third-party disbursements within thirty (30) days of invoice.

6. CONFIDENTIALITY AND DATA PROCESSING

Representative will maintain confidentiality of non-public Materials provided by Registrant and will only disclose such Materials as necessary to obtain Registration or as required by applicable law or WIPO procedures. Registrant consents to Representative's processing of personal data contained in Materials for the purpose of prosecution and recordal of the Registration.

7. NOTICES

All notices or communications required or permitted under this Form shall be in writing and delivered to the addresses set forth below or to such other address as a Party may designate by notice.

8. RECORDINGS, ASSIGNMENTS AND THIRD-PARTY RIGHTS

If any assignment, transfer, license, joint ownership documentation or other third-party consent is required, Registrant shall supply such documents to Representative prior to filing. Representative may file documents of record showing Registrant's entitlement as directed by Registrant and shall not be liable for delays caused by incomplete assignment or title documentation.

9. TERMINATION

Either Party may terminate this authorization upon thirty (30) days' written notice. Termination shall not affect Representative's right to payment for services rendered and disbursements incurred prior to termination.

10. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Form shall be governed by the substantive laws selected by the Parties in the field below. The Parties may select applicable law for interpretation of their obligations. Governing Law:

This Form, together with any attachments and written instructions accepted by Representative, constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior negotiations and agreements, whether written or oral. If any provision of this Form is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

11. AMENDMENTS; WAIVER; COUNTERPARTS

Any amendment to this Form must be in writing and signed by both Parties. No failure or delay by either Party in exercising any right shall operate as a waiver of that right. This Form may be executed in counterparts and by electronic signature, each of which will be deemed an original and all of which together constitute one instrument.

12. CERTIFICATIONS

The Registrant certifies that it has full authority to request the Registration and that the information provided in this Form and in any Materials is accurate. Registrant authorizes Representative to act on Registrant's behalf for the purposes set forth herein.

I hereby certify (check all that apply):

I am the owner of the subject matter or am duly authorized by the owner to act on its behalf.
The Materials submitted are original and do not knowingly infringe third-party rights.
All assignment or title documents necessary for recordal have been provided or will be provided.

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