Document No.
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                                                                                                                                                            IPOPHL-SOP-BOT-01-F01
                                                                                                          O                                                 Rev. No. 03
                                                                                                                                                            Issued by:                         Date:
                                                                                                                                                            BOT
                                                                                        (Prescribed Form)
        .                                           (             O                         ) Please print legibly
    Name*
     Natural                                        Juridical           Country of Residence or Incorporation*
    Complete Address*
    Telephone*                                                                      Facsimile                                                  E-mail Address*
    Name(s) and address(es) of other applicant(s) (Use extra sheets if necessary)
        .
    Agent/Name and Position of Company’s Authorized Representative
    Complete Address in the Philippines
        .                                      (Place a copy of the mark in the box. The mark should be clear enough to be reproduced and digitized)
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                                                                                    C                          f C               ( )
                                                                                    C                    f
                                                                                    Country _______________ Application No. _______________ Date of Filing ______________
                                                                                                         ff
                                                                                     The mark is three-dimensional.  The application is for collective mark.
                                                                                     The mark is a stamped or marked container of goods.
        .                                                                                                                          (                   ( ) f                           )
        .                                                                                           6.                       f
                                                                                                              Big (Total Assets: More than Php 100M)
                                                                                                              Small (Total Assets: Php 100M or less)
                                                                                                               Note: For payments made by cheque or postal money order, it should be
                                                                                                               payable to the                                 .
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