Form DM/1(E) Application for International Registration

DM/1(E)
HAGUE AGREEMENT
CONCERNING THE INTERNATIONAL REGISTRATION OF INDUSTRIAL DESIGNS

APPLICATION FOR INTERNATIONAL REGISTRATION

IMPORTANT
1. The international application may contain several industrial designs (but may not exceed 100). However, all the
industrial designs and/or products in relation to which such designs are to be used must belong to the same class of
the International (Locarno) Classification. The list of classes and subclasses of the Locarno Classification together
with Explanatory Notes is available on the following web site: http://www.wipo.int/classifications/nivilo/.
2. Photographs and other graphic representations of the industrial designs should be pasted or printed directly onto a
separate sheet of A4 paper, white and opaque, in compliance with the instructions made available on document
DM/1.inf.
3. A Fee Calculator is available on the WIPO web site: http://www.wipo.int/hague/en/fees/calculator.jsp.

This cover page must not be sent to the International Bureau.

World Intellectual Property Organization
34, chemin des Colombettes, P.O. Box 18,
1211 Geneva 20, Switzerland
Tel.: +41 (0)22 338 9111
Fax (The Hague Registry): +41 (0)22 740 14 29
e-mail: [email protected] – Internet: http://www.wipo.int
DM/1(E) – April 30, 2013

DM/1(E)
APPLICATION FOR INTERNATIONAL REGISTRATION

For use by the International Bureau

For use by the applicant
This international application contains the following
number of continuation sheets:

Registration No.:
Color:

Filing date:
Reference:

1

APPLICANT
(a) Name:
(b) Address:

(c) Telephone:

Fax:

E-mail address:
If there are several applicants, check box and use a continuation sheet, giving the above required information for each applicant

2

ADDRESS FOR CORRESPONDENCE
(where there are several applicants with different addresses and no representative is appointed, an address for correspondence must be
indicated. Where no such address has been indicated, the address of the person named above shall be treated as the address for
correspondence. If there is only one applicant and no representative is appointed, this item should be completed only if the address for
correspondence is different from the address given in item 1(b))
Address for correspondence:

3

ENTITLEMENT TO FILE
(With respect to each of the entitlement criteria (a) to (d) below, indicate the corresponding Contracting Party or Parties. If any item is
not applicable, write “None”. A list of the Contracting Parties bound by the 1999 Act and/or the 1960 Act is attached to the present
form. Under item (d), only a Contracting Party bound by the 1999 Act may be indicated. Where entitlement is derived from a
connection with a Contracting Party that is a member State of an intergovernmental organization (European Union or African
Intellectual Property Organization (OAPI)), both that member State and that intergovernmental organization should be indicated (such as
“France, European Union”) with respect to any of the corresponding criteria; where entitlement is derived from a connection with a
member State of an intergovernmental organization that is not a Contracting Party, only that intergovernmental organization should be
indicated.)
(a) Nationality:
(b) Domicile:
(c) Real and effective industrial or commercial establishment:

(d) Habitual residence:
If there are several applicants, check box and use a continuation sheet, giving the above required information for each applicant

4

APPLICANT’S CONTRACTING PARTY (where the 1999 Act applies)
(indicate the Contracting Party or one of the Contracting Parties, bound by the 1999 Act and mentioned in item 3, that is to be
considered as the applicant’s Contracting Party.)
Applicant’s Contracting Party:
If there are several applicants, check box and use a continuation sheet, giving the above required information for each applicant

DM/1(E) – April 30, 2013

Page 2

5

APPOINTMENT OF A REPRESENTATIVE (if any)
(a) Name:
(b) Address:

Telephone:

Fax:

E-mail address:
(c) To appoint a representative, the present international application must either be signed by the applicant or be accompanied by a
power of attorney (check the appropriate box):
item 14 of the international application is signed by the applicant
a power of attorney is attached to the present form

6

IDENTITY OF THE CREATOR
(This information is necessary if Bulgaria, Finland, Ghana, Hungary, Iceland, Norway, Romania or Serbia is designated in item 10 – see
paragraphs 35 to 38 of document DM/1.inf.)
(a) Name:
(b) Address:

7

NUMBER OF INDUSTRIAL DESIGN(S), REPRODUCTION(S) AND/OR SPECIMEN(S)
(a) Total number of industrial designs (maximum of 100):
(b) Total number of reproductions:
(i) in black and white:
(ii) in color:
(c) Total number of A4 pages comprising reproductions:
(d) Total number of specimens (if any):

8

PRODUCTS WHICH CONSTITUTE THE INDUSTRIAL DESIGN OR IN RELATION TO WHICH IT IS TO BE USED
(see note 1 on cover page)
Class to which the industrial design(s) belong(s):

No. of the design
(in numerical order)

Product(s)

If the space provided is not sufficient, check this box and use a continuation sheet.

DM/1(E) – April 30, 2013

Subclass
(optional)

Page 3

9

DESCRIPTION
(A brief description is required if Romania or the Syrian Arab Republic is designated)
(Only the characteristic features that appear in a reproduction should be described. The description should not disclose technical
features of the operation of the industrial design or its possible utilization. If the description exceeds 100 words, an additional fee of
2 Swiss francs per word exceeding 100, shall be payable)

If the space provided is not sufficient, check this box and use a continuation sheet.

10

DESIGNATED CONTRACTING PARTIES
Indicate, by ticking the appropriate box, each Contracting Party where protection is sought. The designated Contracting Party must be
bound by an Act – the 1999 Act and/or the 1960 Act – to which one of the Contracting Parties indicated in item 3 is also bound (a list of
Contracting Parties is annexed to the present form):
AL
AM
AZ
BA
BG
BJ
BW
BX
BZ
CH
CI
DE
DK
EE

1

Albania
Armenia
Azerbaijan
Bosnia and
Herzegovina
Bulgaria
Benin
Botswana
Benelux
Belize
Switzerland
Côte d’Ivoire
Germany
Denmark
Estonia

EG
EM
ES
FI
FR
GA
GE
GH
GR
HR
HU
IS
IT
KG

Egypt
European Union
Spain
Finland1
France
Gabon
Georgia
Ghana1
Greece
Croatia
Hungary1
Iceland1
Italy
Kyrgyzstan

KP Democratic People’s
Republic of Korea
LI Liechtenstein
LT Lithuania
LV Latvia
MA Morocco
MC Monaco
MD Republic of Moldova
ME Montenegro
MK The former Yugoslav
Republic of Macedonia
ML Mali
MN Mongolia
NA Namibia
NE Niger
NO Norway

OA African Intellectual
Property Organization
OM Oman
PL Poland
RO Romania
RS Serbia
RW Rwanda
SG Singapore
SI Slovenia
SN Senegal
SR Suriname
ST Sao Tome and Principe
SY Syrian Arab Republic
TJ Tajikistan
TN Tunisia
TR Turkey
UA Ukraine

If Finland, Ghana, Hungary and/or Iceland is/are designated, it is compulsory to indicate, in item 6, the identity of the creator. The latter
declares that he believes himself to be the creator of the industrial design. Where the person identified as the creator is a person other than the
applicant, it is hereby stated that the present international application has been assigned by the creator to the applicant.

DM/1(E) – April 30, 2013

Page 4

11

PRIORITY CLAIM (optional)

If the space provided is not sufficient, check this box and
use a continuation sheet

The applicant claims the priority of the earlier filing mentioned below
Indicate the number of each industrial design for which the priority is, or is not claimed. If no industrial design is indicated, it will be
understood that the priority claim relates to all industrial designs included in the present application:
Priority is claimed for the designs indicated below
Office of earlier filing

12

or

No. of earlier filing
(if available)

Priority is not claimed for the designs indicated below
Date of earlier filing
(dd/mm/yyyy)

INTERNATIONAL EXHIBITION (optional)

No. of the industrial design(s)

If the space provided is not sufficient,
check this box and use a continuation sheet

The applicant claims that one or more designs were shown at an official, or officially recognized, international exhibition
(a) Place where exhibition was held:
(b) Name of the exhibition:
(c) Date on which product(s) was (were) first exhibited:
(d) Number of each industrial design shown, or not shown, at the exhibition concerned (if no industrial design is indicated, it will be
understood that all industrial designs were shown at the above indicated exhibition):
The industrial designs indicated below were
shown at the exhibition concerned

13

or

The industrial designs indicated below were not
shown at the exhibition concerned

PUBLICATION OF THE INTERNATIONAL REGISTRATION
(a) If the reproductions, or some of the reproductions, are in color, they will be published in color.
If the applicant requests the publication of the reproductions in black and white despite the fact that they are presented in
color, check this box
(b) Timing of publication (publication will take place six months after the date of the international registration, unless the applicant
requests one of the options below):
(i) The applicant requests the immediate publication of the international registration
(ii) The applicant requests a deferment of publication


Period of deferment requested (in months):

Warning:
The period of deferment of publication cannot exceed 30 months counted from the date of the international application, or if
priority is claimed, from the priority date. However:
 if Iceland, Poland or Singapore is designated, or if Hungary, Monaco or Ukraine is designated under the 1999 Act,
the applicant may NOT request deferment of publication;
 if Denmark, Finland or Norway is designated, the period of deferment cannot exceed 6 months;
 if a Contracting Party is designated under the 1960 Act, or if Croatia, Estonia, OAPI, Slovenia or the Syrian Arab
Republic is designated, the period of deferment cannot exceed 12 months.

DM/1(E) – April 30, 2013

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14

SIGNATURE BY THE APPLICANT OR HIS REPRESENTATIVE
Applicant

Representative of the applicant

Name:

Name:

Signature and/or seal:

Signature and/or seal:

Date of signature (dd/mm/yyyy):

Date of signature (dd/mm/yyyy):

Name of the person to contact, if necessary:
Telephone:

15

OFFICE PRESENTING THE REQUEST (if applicable)
Name of the Office:
Date of receipt of the international application by the Office:
Signature and/or seal of the Office:

DM/1(E) – April 30, 2013

E-mail address:

Page 6

PAYMENT OF FEES
The applicant has requested a deferment in publication (item 13(b)(ii)) and wishes to pay the publication fees at a later date but not later
than three months before the period of deferment expires.

1. INSTRUCTION TO DEBIT FROM A CURRENT ACCOUNT
(if this box is completed, it is not necessary to complete items 2 and 3 below)
The International Bureau is hereby instructed to debit the required amount of fees from the following current account opened with the
International Bureau:
Holder of the account:

Account number:

Identity of the party giving the instruction:
2. METHOD OF PAYMENT
Identity of the party effecting the payment:
Payment made to WIPO bank account
IBAN No. CH51 0483 5048 7080 8100 0
Credit Suisse, CH-1211 Geneva 70
Swift/BIC: CRESCHZZ80A
Payment made to WIPO postal account
IBAN No. CH03 0900 0000 1200 5000 8
Swift/BIC: POFICHBE

Payment identification

Payment identification

GRAND TOTAL IN SWISS FRANCS
(see note 3 on cover page or use the fee calculation sheet attached herewith)

DM/1(E) – April 30, 2013

dd/mm/yyyy

dd/mm/yyyy

Page 7

FEE CALCULATION SHEET
This sheet is provided for the convenience of users.
It is not necessary to complete it if the fee calculator has been used.
3. AMOUNT OF FEES (see Fee Calculator: www.wipo.int/hague/en/fees/calculator.jsp)
(a)

Basic fees2
for one design
for each additional design
designs in addition to the first
19 Swiss francs 

(b)

397.--

Designation fees
(i) Standard designation fees2 (payable only for Contracting Parties designated under the 1999 or 1960
Act and for which an individual designation fee is not payable)
There are three levels of standard designation fees. Please consult the list of Contracting Parties
annexed to the present form to identify the levels applicable to the respective Contracting Parties.
Level 1:
for first design
42 Swiss francs 
Contracting Parties
for each additional design
designs in addition to the first 
2 Swiss francs 

Contracting Parties

Level 2:
for first design
60 Swiss francs 
Contracting Parties
for each additional design
designs in addition to the first 
20 Swiss francs 

Contracting Parties

Level 3:
for first design
90 Swiss francs 
Contracting Parties
for each additional design
50 Swiss francs 

designs in addition to the first 

Contracting Parties

(ii) Individual designation fee (payable only for the following Contracting Parties)
European
Union:

67 Swiss francs for first design + 67 Swiss francs 

designs in addition to the first

Hungary:

84 Swiss francs for first design + 20 Swiss francs 

designs in addition to the first

Kyrgyzstan: 129 Swiss francs for first design + 64 Swiss francs 
OAPI:

83 Swiss francs for a single design / 124 Swiss francs for a multiple deposit (more than one design)
Applicants from Least Developed Countries:
8 Swiss francs for a single design / 12 Swiss francs for a multiple deposit (more than one design)

Republic of
Moldova:
89 Swiss francs for first design + 9 Swiss francs 
(c)

designs in addition to the first

designs in addition to the first

2

Publication fees

(i) Fee per reproductions
17 Swiss francs 

reproductions

(ii) Fee per page on which reproductions are presented
page(s) in addition to the first
150 Swiss francs 
(d)

Additional fee where the description exceeds 100 words2
2 Swiss francs 

words exceeding 100
GRAND TOTAL (SWISS FRANCS)

2

For international applications filed by applicants whose sole entitlement is a connection with a Least Developed Country (LDC), in accordance with the list
established by the United Nations (www.wipo.int/ldcs/en/country), these fees are reduced to 10% of the prescribed amounts. For the exact applicable
amounts, see the Fee Calculator: www.wipo.int/hague/en/fees/calculator.jsp

DM/1(E) – April 30, 2013

CONTRACTING PARTIES OF THE HAGUE AGREEMENT
(in respect of each Contracting Party, the table below provides indications of the Act or Acts binding that Contracting
Party and further indicates what kind of designation fee is payable for the designation of that Contracting Party*)

Contracting Parties of
the Hague Agreement
(AL)
(AM)
(AZ)
(BA)
(BG)
(BJ)
(BW)
(BX)
(BZ)
(CH)
(CI)
(DE)
(DK)
(EE)
(EG)
(EM)
(ES)
(FI)
(FR)
(GA)
(GE)
(GH)
(GR)
(HR)
(HU)
(IS)
(IT)
(KG)
(KP)
(LI)
(LT)
(LV)
(MA)
(MC)
(MD)
(ME)
(MK)
(ML)
(MN)
(NA)
(NE)
(NO)
(OA)
(OM)
(PL)
(RO)
(RS)
*

Albania
Armenia
Azerbaijan
Bosnia and Herzegovina
Bulgaria
Benin
Botswana
Benelux
Belize
Switzerland
Côte d’Ivoire
Germany
Denmark
Estonia
Egypt
European Union
Spain
Finland
France
Gabon
Georgia
Ghana
Greece
Croatia
Hungary
Iceland
Italy
Kyrgyzstan
Democratic People’s Republic of Korea
Liechtenstein
Lithuania
Latvia
Morocco
Monaco
Republic of Moldova
Montenegro
The former Yugoslav Republic of Macedonia
Mali
Mongolia
Namibia
Niger
Norway
African Intellectual Property Organization
(OAPI)
Oman
Poland
Romania
Serbia

Acts of the Hague Agreement
1999 Act
1960 Act
1
1
1
1
2

1

2
1

1

2
2
2
2
1
IF
3
3
1
3
3
2
IF
3
IF
1
3
2
1
IF
1
1
1
1

1
1
2
1
2

1
1
3
1
2
IF
1
IF
3
1

2
1
IF
1
1
1
1
1

2
IF
1
2
3
3

3
3

A numeral (1, 2 or 3) indicates the applicable level of standard designation fee and the letters “IF” indicate that individual designation fees are
applicable (the amounts of all these fees are indicated in the Fee Calculation Sheet). Where no indication (numeral or letters) appears, this
means that the Contracting Party is not bound by the Act at hand.

DM/1(E) – April 30, 2013

Contracting Parties of
the Hague Agreement
(RW)
(SG)
(SI)
(SN)
(SR)
(ST)
(SY)
(TJ)
(TN)
(TR)
(UA)

DM/1(E) – April 30, 2013

Rwanda
Singapore
Slovenia
Senegal
Suriname
Sao Tome and Principe
Syrian Arab Republic
Tajikistan
Tunisia
Turkey
Ukraine

Acts of the Hague Agreement
1999 Act
1960 Act
1
1
1

1
3
1
2
1
2

1
1
1

2