IPOPHL-SOP-BOT-01-F02 Declaration of Actual Use

Ipophil prescribed declaration form for actual use

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Bureau of Trademarks
(Prescribed Form)

Please check one:



Document No.
Rev. No. 04
Issued by:


Within three (3) years from filing/international registration/subsequent designation
Within one (1) year from the fifth (5th) anniversary of the registration
Within one (1) year from date of renewal
Within one (1) year from the fifth (5 ) anniversary of each renewal
Registered under Republic Act No. 166
[ ] Tenth (10th) anniversary
[ ] Fifteenth (15th) anniversary

I,____________________________________________, of legal age, ____________ citizen, residing at
(name of declarant)
___________________________________________________________, depose and state under oath that:
1. I am the

[ ] applicant for registration
[ ] authorized officer of applicant-corporation
[ ] registrant
[ ] authorized officer of registered owner-corporation
[ ] agent/authorized representative of applicant/registrant
of the mark __________________________________________________________________________

2. The mark was accorded
[ ] Application No. __________________
[ ] Registration No.__________________

] International Reg. No._____________


] International Reg. No. ____________

Filing Date ________________________
Registration Date ___________________
Renewal Date _____________________
International Reg. Date ______________
Subsequent Des. Date_______________
Date of Grant ______________________
Renewal Date______________________

for the following class/es of goods and/or services: (Attach additional sheet/s, if necessary):
3. The Mark is being used in the Philippines for the following class/es of goods and/or services (Attach
additional sheet/s, if necessary): ____________________________________________________________
4. The goods are sold and/or services are rendered in the following outlet/s:
Name of Outlet
5. As proof of actual use, attached are labels or pictures of the Mark (or pictures of the stamped container
visibly or legibly showing the Mark) or other evidence of use.
6. This affidavit is executed to attest to the truth of the foregoing and for the purpose of complying with the
requirements of R.A. 8293 and the Trademark Regulations, as amended.
SUBSCRIBED AND SWORN TO before me this _____________ day of __________________________,

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