I/We undersigned                                              : .........................................................................................................….
(Saya/kami yang bertanda tangan dibawah ini)

Acting to this present as                                     : ..........................................................................................................…
(Dalam hal ini bertindak selaku)

Of and therefore on behalf of                             : .............................................................................................................
(Oleh karenanya untuk dan atas nama)

A corporation organized under the laws of          : ..............................................................................................................
(Suatu perseroan menurut Undang-Undang)

Residing/having principal office at                       : ..............................................................................................................
(Beralamat/Berkantor Pusat di) 
                                                                          ........................................................................................................…..

In this case electing legal domicile at the office of proxies mentioned below :
(Dalam hal ini memilih tempat kedudukan hukum di kantor kuasa-kuasa yang disebutkan dibawah ini)

HERI HERJANDONO, SH. (100-2006)
 
of the :
(dari)

A & J - Intellectual Property Rights
Patents, Trademarks, Copyrights, Industrial Design & Law Firm
Jl. Bukit Gading Raya Blok A No. 10
Komp. Bukit Gading Indah, Kelapa Gading Barat
Jakarta 14240 - Indonesia
Phone: (62-21) 451 3622
Fax: (62-21) 458 41543
E-mail: aj@aj.co.id
http://www.aj.co.id

SPECIFICALLY (KHUSUS)

 Either jointly or severally to act on my/our behalf with full power of substitution in all trademark proceeding at The Trademark Registry in ndonesia, to take every necessary action in respect of :
(Baik bersama-sama maupun sendiri-sendiri bertindak atas nama saya/kami dengan hak substitusi untuk melakukan segala tindakan yang diperlukan di Kantor Merek di Indonesia sehubungan dengan hal-hal :)

(    )  Filing application for registration of trademark/service mark/copyrights of:
         (Mengajukan permohonan pendaftaran merek dagang/merek jasa/ciptaan)

(    )  Filing application for renewal of trademark/service mark registration of:
         (Mengajukan permohonan pembaharuan pendaftaran merek dagang/merek jasa atas)

(    )  Recordal of assignment/change of name/address or abandonment of trademark/service mark/copyrights of :
         (Pencatatan pemindahan hak/perubahan nama/perubahan alamat/pembatalan merek dagang/merek jasa /ciptaan)

(    )  Withdrawal or rectification of Trademark/service mark/copyrights application of:
         (Penarikan kembali atau pembetulan permohonan pendaftaran merek dagang/ merek jasa/ciptaan)

(    )  Filing petition for of recordal of wellknown mark/objection/appeal/non renewal.
         (Mengajukan permohonan pencatatan merek terkenal/Keberatan/Banding/Penolakan pembaharuan merek)

Date :
(Tanggal)

Signature :
(Tanda tangan)