3. TITLE OF INVENTION (Must agree with the PCT publication document if applicable.)

Transcription

1 1. CLIENT INFORMATION Name : Telephone: Facsimile: 2. CASE REFERENCE: 3. TITLE OF INVENTION (Must agree with the PCT publication document if applicable.) 4. DETAILS OF INTERNATIONAL APPLICATION Application Number : International Filing Date: Priority Date: International Publication Number: International Publication Date: Due Date for Filing Request:

2 5. APPLICANT: (As named in the International Application) 6. INVENTOR(S) (Please provide full names) Name: Name : Name: Name: 7. PRIORITY APPLICATION(S) If priority is to be claimed, please list all prior related applications outside Canada including any application filed more than 12 months ago. Country: KEGB 2004 Page 2 of 6 REV. 11/15

3 Serial No.: Filing Date: Applicant: Country: Serial No.: Filing Date: Applicant: 8. LANGUAGE OF INTERNATIONAL APPLICATION ENGLISH FRENCH OTHER: 9. DETAILS OF INTERNATIONAL PROSECUTION The International prosecution took place under: CHAPTER I CHAPTER I & II 10. AMENDMENTS DURING INTERNATIONAL PHASE ARTICLE 19 ARTICLE 34 OTHER: STATEMENT UNDER ARTICLE 19 SUBMITTED 6. DOCUMENTS REQUIRED Please indicate which of the following documents are provided. ENCLOSED TO FOLLOW Translation of International Application (as amended)* KEGB 2004 Page 3 of 6 REV. 11/15

4 Assignment** Copy of International Application as Published*** International Search Report International Preliminary Examination Report (IPER) Substitute Sheets (if any, from IPER) Other Correspondence Affecting Application * A translation of the International application is required if the application was neither filed nor published in English or French. The translation must include the abstract, disclosure, claims, any text appearing in the drawings, any statements made under Article 19(1) and any amendments made during the International Phase. We must indicate to the Patent Office that amendments have been incorporated into the translation, if this is the case. ** An assignment is required if the International application was filed other than by the inventors. The assignment document should be filed within one year of the national phase entry date if not, it will be requisitioned by the Patent Office. We can prepare an assignment ready for signature, if you wish. *** A copy of the International application is required for our file. If not provided, we can download this (from the WIPO website) for a fee. Please specify if you require Kirby Eades Gale Baker to prepare any of the above documentation. 11. EXAMINATION REQUEST Substantive examination of a patent application in Canada may be deferred for a period of 5 years from the International filing date. KEGB 2004 Page 4 of 6 REV. 11/15

5 Please request substantive examination of this application Please defer substantive examination of this application 12. PROSECUTION OF APPLICATION Do you hereby instruct Kirby Eades Gale Baker to take all steps to keep the application in force in the absence of instructions to the contrary (with the exception of the payment of maintenance fees, see below): YES NO 13. MAINTENANCE FEES Annual maintenance fees for this application are payable commencing two years from the International filing date. PLEASE SELECT ONE OF THE FOLLOWING: 14. ADDITIONAL INSTRUCTIONS: PAY AUTOMATICALLY WITHOUT INSTRUCTIONS ANNUITY SERVICE TO INSTRUCT SEND REMINDER SHORTLY BEFORE (e.g. Do you require Kirby Eades Gale Baker to review or revise the application prior to National Phase entry? Special instruction(s) pertaining to the date of national phase entry in Canada.) KEGB 2004 Page 5 of 6 REV. 11/15

6 Signature: Date: Please mail, or fax completed form along with all the additional application material to: Kirby Eades Gale Baker Intellectual Property 100 Murray St., Suite 500 Ottawa, ON K1N 0A1 P: F: KEGB 2004 Page 6 of 6 REV. 11/15