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Please fill in personal full name as per shown on the personnel identity card. A copy of personnel identity card is required.
Please fill in the company name as per shown on the Company/Business Registration Certificate. A copy of Company/Business Registration Certificate is required.
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Nepal (np)
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Philippines (ph)
Pakistan (pk)
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Saint Pierre and Miqu (pm)
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Somalia (so)
Suriname (sr)
Saint Tome (Sao Tome) (st)
Former USSR (su)
El Salvador (sv)
Syria (sy)
Swaziland (sz)
Turks and Caicos Islands (tc)
Chad (td)
French Southern Territories (tf)
Togo (tg)
Thailand (th)
Tadjikistan (tj)
Tokelau (tk)
Turkmenistan (tm)
Tunisia (tn)
Tonga (to)
East Timor (tp)
Turkey (tr)
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Vietnam (vn)
Vanuatu (vu)
Wallis and Futuna Islands (wf)
Samoa (ws)
Yemen (ye)
Mayotte (yt)
serbia (rs)
South Africa (za)
Zambia (zm)
Prince Nizam Zambri Isle (zn)
Zaire (zr)
Zimbabwe (zw)
montenegro (me)
Curacao (cw)
Bonaire, Saint Eustatius and Saba (bq)
*
Phone Number (e.g : +603.89966788)
+
.
Fax Number (e.g : +603.89966788)
+
.
*
Email
*
Identity No
*
Date of Birth (yyyy-mm-dd)
*
Organization Type
-- Please Select --
Company
Business
Non Profit Organization
Education
Legal Professional
Others
*
Registration No
Nexus Requirements (Applicable for U.S Entity or Natural Person)
-- Please Select --
A permanent resident of U.S. or any U.S. territory
An entity that has an office or facility in the U.S.
An entity that regularly engages in lawful activities
Citizen or National of the United States
Incorporated within one of the U.S. states or U.S. territory
Billing Contact
Same as Registrant Contact
Same as Administrative Contact
Same as Technical Contact
*
Contact Type
Individual
Organization
*
Company
Please fill in personal full name as per shown on the personnel identity card. A copy of personnel identity card is required.
Please fill in the company name as per shown on the Company/Business Registration Certificate. A copy of Company/Business Registration Certificate is required.
*
First Name
*
Last Name
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Address1
Address2
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City
State
*
Zip
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Country
Andorra (ad)
United Arab Emirates (ae)
Afghanistan (af)
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Albania (al)
Armenia (am)
Sint Maarten (sx)
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Office for Harmonization in the Internal Market (Trademarks and Designs)(OHIM) (em)
Spain (es)
Ethiopia (et)
Finland (fi)
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Falkland Islands (fk)
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Gabon (ga)
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