REPUBLIC OF ZAMBIA
PATENTS FORM NO. 3
Sections 11, 12, 31 (1)
Regulation 3 (3)
THE PATENTS ACT
Fee units: 40
APPLICATION FOR A PATENT OF ADDITION
I/We (1)
(1) State
full name
and address
of
applicant(s)
being a national/nationals of
do hereby declare that I am/we are the owner(s) of an invention the title of which is (2)
(2) Here
insert title
of
invention
and that I am/we are the (3) assignee(s)/legal representative(s) of (4)
(3) Delete
if not
applicable
(4) Here
insert
name(s) of
inventor(s)
who claim(s) to be the inventor(s) thereof; that the said invention is an improvement in or
modification of my/our invention for which a patent was applied for/granted under
No. (5)
;
that to the best of my/our knowledge and belief there is no lawful ground of objection to the
grant of a patent to me/us on this application and I/we pray that a patent may be granted to
me/us for the said invention as a patent of addition and request that the term of such further
patent may be the same as that of the patent for the main invention or so much of that term
as is unexpired
Dated this
(6)
day of ...........................................,19 ................
(5) Here
insert
number of
main
patent or
patent
application
(6) To be
signed by