______________________________________________________________________
_____________________________
7.

PRIORITY CLAIM (if any)
The priority of an earlier application is claimed as follows:
Country (if the earlier application is a regional or international application, indicate the

office with which it is filed)
………………………………………………………………………………………………………
………………………………………… Filing date…………………………..
Application Number:………………………………
The priority of more than one earlier application is claimed:

Yes

No

The data are indicated in the supplemental box * (at annex)
The certified copy of the earlier application
accompanies this Form
will be furnished within three months of the filing of this Form
______________________________________________________________________________
_____________________
8.

SUPPIEMENTAL BOX* (at annex)
Additional information is contained in Supplemental box:

Yes

No

______________________________________________________________________________
_____________________
9.

DEFERMENT OF PUBLICATION
Deferment

of

publication

(under

section

37

of

the

Act)

till………………………………………………(date)
______________________________________________________________________________
_____________________10.

Date: …………………………………

SIGNATURE:………………………………………
**(Applicant/Agent)

________
* Use this Box for any additional information to be furnished
** Use additional sheets whenever necessary
*** Delete whichever is not applicable.

Annex

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