NOTICE OF CLAIMED IPR INFRINGEMENT
Date	:

Attn.: Legal Department
Fax Number : 

Dear Sirs,

I, the undersigned, state UNDER PENALTY OF PERJURY that:
•	I am the owner (“IPR Owner”) of certain intellectual property rights (“IPR”) or the authorized agent of the IPR owner;
•	I have a good faith belief that the listings identified below offer items or certain materials that are not authorized by the IPR Owner, its agent, or the law, and therefore infringe the IPR Owner’s rights; and
•	The information in this notice is accurate.

Name of the alleged Infringing Companies:	The specific URLs of each and every alleged infringing products:	The IPR relates  to:
Trademark/ Patent/ Copyright 	Description of IPR:
•	Country in which the right is valid
•	Registration number and year of  registration
	Description of infringement, for example: 
•	trademark reproduced
•	copyrighted image/ packaging reproduced 
•	infringement on design patent
•	infringement on invention/ utility patent	

					

Please attach the relevant certificate of IPR. If the undersigned is the authorized agent of the IPR owner, please attach a valid attorney’s letter regarding IP protection authorization. 

My request is: ________________________________________________________________________________________________________                                                                       

I may be contacted at (required *):
Name of IPR Owner*:                              Name of IPR Owner’s Agent (if applicable): 		                                        
Name and Title*:                                                             Address*: 	                                                                         
Email address*:                                      Telephone*:                                           Fax: 	                                            
	
Signature