| Company Name:* |
(put N/A if not applicable) |
| Contact Person:* |
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| Address1:* |
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| Address2: |
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| City:* |
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| State/Region/Province:* |
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| Country:* |
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| Zip:* |
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| Tel No:* |
(Country Code)
(Phone Number) |
| Mobile No:* |
(Country Code)
(Mobile Number) |
| Fax No:* |
(Country Code)
(Fax Number) |
| Email Address: * |
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| Domain Name |
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| Applying for Phase |
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| Registered TradeMark * |
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The full name of the body, that corresponds to the Domain name applied for. This field may optionally include a URL pointing to supporting documentation e.g. ABC company ltd.
[http://company.ltd/trademark.pdf]. |
| Pre-Verification Number |
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A verification no. supplied by the DOTAsia verification agent for any application which has already been verified and approved. |
| TradeMark Registered in * |
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Location (country/economy) where the right is established. |
| TradeMark Registration No. * |
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Registration or serial number of the registered mark's current registration. This number must enable the verification agent to access the correct registration entry in the trademark registry or trademark office. |
| TradeMark Applied On |
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Exact date when the registered mark was applied (corresponding to the registration described by the registration number and registration locality). |
| TradeMark Registered On * |
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Exact Date on which the registration of registered mark becomes effective. (The day for which the mark is issued and registered). |
| TradeMark Registered As * |
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http://wipo.int/classifications/nivilo/nice/index.htm |
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Class of the registered mark. If more than one class has been registered with the domain, any one can be used. |
| Entitlement * |
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Weather the applicant (corresponding to the registrant contact) holds the trademark as the original “OWNER”, “CO-OWNER” or “ASSIGNER”. |
| Entity Type * |
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| Identification Type * |
Certficate Of Incorporation or equivalent business certificate issued by the relevent government registry as confirmation of the due incorporation and valid existence of the company |
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Act,decree or legislation chartering the information of an Entity |
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Societies Registry or equivalent registry for non-cooperate entities |
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Political Parties Registry |
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Passport or Citizenship ID |
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Other |
| Identification Number * |
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Code of reference (e.g. Passport number, business certificate number, act or legislation number/code, etc.). |
| Upload Scanned TradeMark Document * |
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| Employee Name/ Code |
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Code of reference (e.g. Passport number, business certificate number, act or legislation number/code, etc.). |
| Note: |
| 1.) I have read, understood and abide the eligibility criteria |
| 2.) Non-refundable processing fee to be charged 4,000 (in INR)/ 100 (in USD) per domain. |
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I Accept Terms & Conditions |
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