ChronosMark Portfolio Services

1. Registration Details

U.S. Registration Number *

Registration Date *

Literal Mark Text *

2. Owner / Registrant Information

Current Owner Name *

Check this box if current owner name differs from TSDR record (assignment, merger, or legal name change).

Upload Chain-of-Title / Assignment Proof (PDF/JPG) *

Domicile Country *

Owner Email *

Mailing Address *

City *

State / Zip Code *

3. Attorney Information (Optional for U.S. Owners)

Attorney Name

Law Firm Name

Bar Jurisdiction / State

Bar Membership Number

Attorney Email

4. Requested Changes & Scope

1. Amend Mark Image / Text (Minor non-material change)

2. Modify Additional Statements (Disclaimers, Translations, Prior Regs)

3. Restrict/Delete Goods, Services, or Classes

4. Correct / Modify Dates of Use

4A. Proposed Mark Amendment & Conforming Specimens

Amended Mark Type *

Proposed New Mark Wording

Upload New Mark Image File (JPG required for Stylized/Design)

Conforming Specimen Uploads (Required for Mark Amendments)

Primary Conforming Specimen *

Description *

Webpage URL

Date Webpage Accessed

Backup Specimen #1 (Optional)

Description

Webpage URL

Date Webpage Accessed

Backup Specimen #2 (Optional)

Description

Webpage URL

Date Webpage Accessed

4B. Additional Statements

Disclaimer Statement

English Translation

Active Prior U.S. Registrations

4C. Restrict / Delete Goods or Services

Items / Classes to Delete

Final Revised Goods/Services Listing

4D. Correct / Modify Dates of Use

Date of First Use Anywhere

Date of First Use in Commerce

5. Explanation of Filing & Fee Allocation

Source of Correction / Error *

Detailed Background Facts & Reason for Request *

6. Electronic Signature

Signatory Relationship / Capacity *

Signatory Name *

Official Title *

Electronic Signature *

Section 7 Request Intake

1. Registration Details

2. Owner / Registrant Information

3. Attorney Information (Optional for U.S. Owners)

4. Requested Changes & Scope

4A. Proposed Mark Amendment & Conforming Specimens

Conforming Specimen Uploads (Required for Mark Amendments)

4B. Additional Statements

4C. Restrict / Delete Goods or Services

4D. Correct / Modify Dates of Use

5. Explanation of Filing & Fee Allocation

6. Electronic Signature