Applicant's or Agent's File reference:…………………………………….
______________________________________________________________________________
_____________________
THE APPLICANT(S) REQUEST(S) THE GRANT OF A PATENT IN RESPECT OF THE
FOLLOWING PARTICULARS:
1.
Title of invention
………………………………………………………………………………………………
…………………………………….
………………………………………………………………………………………………
…………………………………….
______________________________________________________________________________
___________________
2.
DATA CONCERNING APPLICANT/S
FULL NAME OF EACH
ADDRESS/
APPLICANT
TELEPHONE/
(underline surnames)
FAX/E-MAIL
NATIONALITY
RESIDENCE
If the applicant is a corporate body, give the country/state of its incorporation:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………………………………………….
3.
ADDITIONAL INFORMATION
Additional Information is contained in Supplemental Box* (at annex).
Yes
______________________________________________________________________________
_____________________
4.
INVENTOR
(a)
Applicant is the inventor
Yes
No