FORMULIR PERMOHONAN PENDAFTARAN MEREK INDONESIA

APPLICATION FORM OF INDONESIAN TRADEMARK REGISTRATION

Data Permohonan (Application)

Nomor Transaksi : IPT2024052611 Asal Permohonan : Online Filing
Number of Transaction Office of Origin
Nomor Permohonan : IPT2024052611 Tipe Permohonan : Merek Dagang
Number of Application Type of Application
Tanggal Penerimaan : 2024-03-20 07:58:51 Jenis Permohonan : Umum
Receipt Date Sub Type of Application

Data Merek (Description of Mark)

Tipe Merek : Merek Kata dan Lukisan Etiket Gambar/Label Merek
Type of Mark Image of Mark
Nama Referensi Label Merek : MIEKIRIN
Reference Name in Mark
Label

Deskripsi :
Description

Warna : COKLAT, KUNING, HIJAU

Colors

Terjemahan : Tidak Ada Terjemahan

Translation

Transliterasi/Pengucapan :
Transliteration

Disclaimers :
Disclaimers

Data Pemohon (Applicant)

Signed by IPROLINE Merek

on 2024/03/20 08:08:28
Nama : ANDRIY GIOVANNI
Name
Jenis Pemohon : Perorangan
Owner Type
Kewarganegaraan : Indonesia
Nationality
Alamat : DESA SEI AMBANGAH KUMPAI BESAR RT01/RW05
Address

Kabupaten/Kota : Kabupaten Kubu Raya Kode Pos :

City Zip Code
Provinsi : Kalimantan Barat Negara : Indonesia
Province Country
Telepon : 081352222984
Phone
Surel : ANDRIY.001@SKI.SCH.ID
Email

Alamat Surat Menyurat (Mailing Address)

Alamat :
Address

Kabupaten/Kota : Kode Pos :

City Zip Code
Provinsi : Negara :
Province Country
Telp/Fax :
Phone
Surel :
Email

Data Kuasa (Representative/IP Consultant)

Nama Konsultan : No Konsultan :
Consultant Name Number of Consultant
Nama Kantor :
Office Name
Alamat :
Address

Telp/Fax :
Phone
Surel :
Email

Data Prioritas (Priority Data)

Tanggal Prioritas Negara / Kantor Merek No Prioritas

No
(Priority Date) (Priority Country) (Number of Priority)
Data Kelas (Class)

Kelas Uraian Barang dan/atau Jasa

(Class) (Description of Goods/Services)
30 pasta kacang miso; Mie; onigiri [bola nasi]; teh oolong [teh Cina]; teh melati; Mie jepang; mie ramen; Teh
hijau jepang; Mie Korea; Mie shirataki

miso bean paste; noodles; onigiri [rice balls]; oolong tea [Chinese tea]; jasmine tea; Japanese noodles;
ramen noodles; Japanese green tea; Korean noodles; Shirataki Noodles

Dokumen Lampiran (Attachment)

Tanda Tangan Digital Pemohon

Identitas pemohon jika pemohon lebih dari satu pihak (Additional Applicant)

No Nama Pemohon Tambahan

Gambar Merek Tambahan (Additional Mark)

No Gambar Merek Tambahan

Tanda Tangan Pemohon / Kuasa (Applicant / Representative Signature)

(ANDRIY GIOVANNI)
Tempat dan Tanggal (Place and Date) : Jakarta, 20-03-2024