Specification of the purpose of use of the mandate
with the mandate reference number:	Contact details:
ZUEV8205	Person authorising the mandate:
Telephone:
Telefax:
E-mail:
(1)	The mandate shall be used for the following procedures:
Official file number:	Fee number	Amount in €	Explanatory notes
In case you intend to indicate multiple file numbers, please refer to our notes on collective payments at www.dpma.de.
Internal file number:	Total amount:	If the fee number is unknown, you can give more details on the payment’s purpose in this column.
IP right owner’s name:
In procedures with multiple parties (opposition, cancellation), official file number of the contested IP right:
(2)	Use for future payments (permanent collection)
The mandate shall also be used for fees and costs to be paid in the future relating to the official file number under (1) or the file numbers given in the attached collective payment list until cancelled. (Note: only possible if field S12-5 "Recurrent payments" in the SEPA Core Direct Debit Mandate (form A 9530) has been ticked.)
(3)	Notifications of change
The payments for the following official file numbers shall no longer be debited based on the mandate:
File numbers:
1.	3.
2.	4.
The mandate with the above-mentioned mandate reference number shall be revoked completely.
Other:
Place, date	Signature