Changes to the activity title Name or Firm of the HolderName or Firm of the HolderNIF/NIPC (VAT ID #)NIF/NIPC (VAT ID #)Number of Activity TitleNumber of Activity TitleChange typeChange of company nameChange of company nameSelect an option NoYesChange in tax domicileChange in tax domicileSelect an option NoYesChange of address or area of the establishmentChange of address or area of the establishmentSelect an option NoYesEndorsement of the title of activity without establishment — Distance Media — to include website(s) where the marketing takes place.Endorsement of the title of activity without establishment — Distance Media — to include website(s) where the marketing takes place.Select an option NoYesCancellation of the activity or website(s) (Not subject to charge)Cancellation of the activity or website(s) (Not subject to charge)Select an option NoYesChange of contact details (not subject to charge)Change of contact details (not subject to charge)Select an option NoYesNew company nameDeclaration of commencement of activityPermanent certificate codePermanent certificate codeAddress or residence for tax purposesAddress or residence for tax purposesPostal CodePostal CodeTown/CityTown/CityParishParishMunicipalityMunicipalityDistrictDistrictNew company nameDeclaration of commencement of activityPermanent certificate codePermanent certificate codeAddress or place where the activity is carried outAddress or place where the activity is carried outArea (number of square metres) or sale dimension of space, location or commercial establishmentArea (number of square metres) or sale dimension of space, location or commercial establishmentPostal code of the establishment where the activity is carried outPostal code of the establishment where the activity is carried outLocation of the establishment where the activity is carried outLocation of the establishment where the activity is carried outParish of the establishment where the activity is carried outParish of the establishment where the activity is carried outMunicipality of the establishment where the activity is carried outMunicipality of the establishment where the activity is carried outDistrict of the establishment where the activity is carried outDistrict of the establishment where the activity is carried outPlease attach: Justifying document of possession or legitimate occupation of the area where the activity is expected to be carried outPlease attach: Justifying document of possession or legitimate occupation of the area where the activity is expected to be carried outRemove fileNumber of Activity TitleNumber of Activity TitleWebsite(s) on which the marketing activity is carried outWebsite(s) on which the marketing activity is carried outActivity numberActivity numberIf you are the holder of a responsibility mark you may request the maintenance of the responsibility mark for a maximum period of 5 yearsI wish to keep the responsibility markResponsibility Mark numberResponsibility Mark numberFor the purpose of updating data, you should notify the Assay Office whenever you no longer market on a given websiteFor the purpose of updating data, you should notify the Assay Office whenever you no longer market on a given websiteWrite all the links you want to cancelNameNameMobile phoneMobile phonePhonePhoneEmail addressEmail addressCustomer Data/InvoiceName/CompanyName/CompanyAddressAddressPostal CodePostal CodeTown/CityTown/CityCountryCountrySelect an option AndorraUnited Arab EmiratesAfghanistanAntigua and BarbudaAnguillaAlbanyArmeniaNetherlands AntillesAngolaAntarcticaArgentinaAmerican SamoaAustriaAustraliaArubaAzerbaijanBosnia HerzegovinaBarbadosBangladeshBelgiumBurkina FasoBulgariumBahrainBurundiBeninBlueBermudaBrunei DarussalamBoliviaBrazilBahamasBhutanBouvet IslandsBotswanaBelarusBelizeCanadaCoconut IslandsCongo RepublicCentral African RepublicCongoSwitzerlandIvory CoastCook IslandChileCameroonChinaColombiaCosta RicaSerbia and MontenegroCubaCape VerdeChristmas IslandCyprusCzech republicGermanyDjiboutiDeenmarkDominicaDominican RepublicAlgeriaEcuadorEstoniaEgyptWestern SaharaEritreiaSpainEthiopiaEuropean UnionFinlandFijiFalkland IslandsMicronesiaFaroe IslandsFranceGabonUnited KingdomGrenadaGeorgiaFrench GuianaGhanaGibraltarGreenlandGambiaGuineaGuadeloupeEquatorial GuineaGreeceSouth Georgia and the South Sandwich IslandsGuatemalaGuamGuinea BissauGuyanaHong KongHeard and McDonald IslandsHondurasCroatiaHaitiHungaryIndonesiaIrelandIsraelIndiaBritish Territory in the Indian OceanIraqIranIcelandItalyJerseyJamaicaJordanJapanKenyaKyrgyzstanCambodiaKiribatiComorosSaint Kitts and NevisNorth KoreaSouth KoreaKuwaitCayman IslandsKazakhstanLaosLebanonSaint LuciaLiechtensteinSri LankaLiberiaLesothoLithuaniaLuxembourgLatviaLibyaMoroccoMonacoMoldovaMadagascarMarshall IslandsMacedoniaMaliMyanmarMongoliaMacaoNorthern MarianasMartiniqueMauritaniaMontserratMaltaMauritiusMaldivesMaláwiMexicoMalaysiaMozambiqueNamibiaNew CaledoniaNigerNorfolk IslandNigeriaNicaraguaNetherlandsNorwayNepalNauruNatoNiueNew ZealandOmanAlaranjadoPanamaPeruFrench PolynesianPapua New GuineaPhilippinesPakistanPolandSaint Peter and MiquelonPitcairn IslandPuerto RicoPalestinePortugalPalauParaguayQatarReuniãoRomaniaRussian FederationRwandaSaudi ArabiaSolomon IslandsSeychellesSudanSwedenSingaporeSaint HelenSloveniaSvalbardSlovakiaSierra LeoneSan MarinoSenegalSomaliaSurinameSão Tomé and PríncipeEl SalvadorSyriaSwazilandTurks and Caicos IslandsChadTogoThailandTajikistanTokelau IslandsEast TimorTurkmenistanTunisiaTongaTimor LesteTurkeyTrinidad and TobagoTuvaluTaiwanTanzaniaUkraineUgandaUS Minor IslandsUnited NationsUSAUruguayUzbekistanVaticanSaint Vincent and the GrenadinesVenezuelaVirgin Islands (United Kingdom)US Virgin IslandsVietnamVanuatuWallis and FutunaWestern SamoaYemenMayotteSouth AfricaZambiaZimbabweTaxpayer #Taxpayer #Email addressEmail address
