PCT - WIPO

1 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.)This person is also inventorThis person is applicantfor the purposes of:all designated Statesthe States indicated in the Supplemental BoxState (that is, country) of residence:State (that is, country) of nationality:Box No.

2 IIIFURTHER APPLICANT(S) AND/OR (FURTHER) INVENTOR(S)Box No. IVAGENT OR COMMON REPRESENTATIVE; OR ADDRESS FOR CORRESPONDENCEThe person identified below is hereby/has been appointed to act on behalfof the applicant(s) before the competent International Authorities as:Name and address:Further applicants and/or (further) inventors are indicated on a continuation (Family name followed by given name; for a legal entity, full official address must include postal code and name of country.)See Notes to the request formForm PCT/RO/101 (first sheet) (July 2018)Address for correspondence: Mark this check-box where no agent or common representative is/has been appointed and thespace above is used instead to indicate a special address to which correspondence should be No.

3 agent s registration No. with the OfficeFacsimile No. Applicant s registration No. with the OfficeFacsimile authorization: Marking one of the check-boxes below authorizes the receiving Office, the International Searching Authority, theInternational Bureau and the International Preliminary Examining Authority to use the e-mail address indicated in this Box to send,notifications issued in respect of this international application to that e-mail address if those offices are willing to do address:as advance copies followed by paper notifications; orexclusively in electronic form (no paper notifications will be sent).E-mail authorization: Marking one of the check-boxes below authorizes the receiving Office, the International Searching Authority, theInternational Bureau and the International Preliminary Examining Authority to use the e-mail address indicated in this Box to send,notifications issued in respect of this international application to that e-mail address if those offices are willing to do address:as advance copies followed by paper notifications; orexclusively in electronic form (no paper notifications will be sent).

4 Form PCT/RO/101 (continuation sheet) (July 2018)See Notes to the request formState (that is, country) of nationality:State (that is, country) of residence:State (that is, country) of nationality:State (that is, country) of residence:Name and address:State (that is, country) of nationality:State (that is, country) of residence:State (that is, country) of nationality:State (that is, country) of residence:Name and address:Name and address:Sheet No..Box No. IIIFURTHER APPLICANT(S) AND/OR (FURTHER) INVENTOR(S)If none of the following sub-boxes is used, this sheet should not be included in the applicants and/or (further) inventors are indicated on another continuation and address:(Family name followed by given name; for a legal entity, full official address must include postal code and name of country.)

5 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.)(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.)(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.)(Family name followed by given name; for a legal entity, full official address must include postal code and name of country.

6 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.) Applicant s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.)applicant and inventorThis person is:applicant only Applicant s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.)applicant and inventorThis person is:applicant only Applicant s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.)applicant and inventorThis person is:applicant only Applicant s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.

7 Applicant and inventorThis person is:applicant onlyThis person is applicantfor the purposes of:all designated Statesthe States indicated in the Supplemental BoxThis person is applicantfor the purposes of:all designated Statesthe States indicated in the Supplemental BoxThis person is applicantfor the purposes of:all designated Statesthe States indicated in the Supplemental BoxThis person is applicantfor the purposes of:all designated Statesthe States indicated in the Supplemental BoxSheet No..Supplemental Box If the Supplemental Box is not used, this sheet should not be included in the Notes to the request formForm PCT/RO/101 (supplemental sheet) (July 2018) , in any of the Boxes, except Boxes Nos. VIII(i) to (v) for whicha special continuation box is provided, the space is insufficientto furnish all the information: in such case, write Continuationof Box (indicate the number of the Box) and furnish theinformation in the same manner as required according to thecaptions of the Box in which the space was insufficient, inparticular:(i)if more than one person is to be indicated as applicant and/orinventor and no continuation sheet is available: in suchcase, write Continuation of Box No.

8 III and indicate for eachadditional person the same type of information as required inBox No. III. The country of the address indicated in this Box isthe applicant s State (that is, country) of residence if no State ofresidence is indicated below;(ii) if, in Box No. II or in any of the sub-boxes of Box No. III, theindication the States indicated in the Supplemental Box ischecked: in such case, write Continuation of Box No. II or Continuation of Box No. III or Continuation of Boxes No. IIand No. III (as the case may be), indicate the name of theapplicant(s) involved and, next to (each) such name, the State(s)(and/or, where applicable, ARIPO, Eurasian, European orOAPI patent) for the purposes of which the named person isapplicant;(iii) if, in Box No.

9 II or in any of the sub-boxes of Box No. III, theinventor or the inventor/applicant is not inventor for thepurposes of all designated States: in such case, write Continuation of Box No. II or Continuation of Box No. III or Continuation of Boxes No. II and No. III (as the case maybe), indicate the name of the inventor(s) and, next to (each)such name, the State(s) (and/or, where applicable, ARIPO,Eurasian, European or OAPI patent) for the purposes of whichthe named person is inventor;(iv) if, in addition to the agent (s) indicated in Box No. IV, there arefurther agents: in such case, write Continuation ofBox No. IV and indicate for each further agent the same typeof information as required in Box No.

10 IV;(v) if, in Box No. VI, there are more than three earlier applicationswhose priority is claimed: in such case, write Continuationof Box No. VI and indicate for each additional earlierapplication the same type of information as requiredin Box No. the applicant intends to make an indication of the wish thatthe international application be treated, in certain designatedStates, as an application for a patent of addition, certificate ofaddition, inventor s certificate of addition or utility certificateof addition: in such case, write the name or two-letter code ofeach designated State concerned and the indication patent ofaddition, certificate of addition, inventor s certificate ofaddition or utility certificate of addition, the number of theparent application or parent patent or other parent grant andthe date of grant of the parent patent or other parent grant orthe date of filing of the parent application (Rules (a)(i)and (a) or (b)).