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PCT - WIPO

Box No. IIAPPLICANTBox No. ITITLE OF INVENTIONPCTThe undersigned requests that the presentinternational application be processedaccording to the Patent Cooperation s or agent s file reference(if desired) (12 characters maximum)For receiving Office use onlyInternational Application Filing DateName of receiving Office and PCT International Application Name and address:(Family name followed by given name; for a legal entity, full official address must include postal code and name of country. The country of the address indicated in thisBox is the applicant s State (that is, country) of residence if no State of residence is indicated below.)

Supplemental Box If the Supplemental Box is not used, this sheet should not be included in the request. Form PCT/RO/101 (supplemental sheet) (January 2022) See Notes to the request form 1. If, in any of the Boxes, except Boxes Nos. VIII(i) to (v) for which a special continuation box is provided, the space is

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