Sheet No. . . . Continuation of Box No. II International application No. APPLICANT(S) If none of the following sub-boxes is used, this sheet should not be included in the demand. Name and address: (Family name followed by given name; for a legal entity, full official designation. The address must include postal code and name of country.) State (that is, country) of nationality: State (that is, country) of residence: Name and address: (Family name followed by given name; for a legal entity, full official designation. The address must include postal code and name of country.) State (that is, country) of nationality: State (that is, country) of residence: Name and address: (Family name followed by given name; for a legal entity, full official designation. The address must include postal code and name of country.) State (that is, country) of nationality: State (that is, country) of residence: Name and address: (Family name followed by given name; for a legal entity, full official designation. The address must include postal code and name of country.) State (that is, country) of nationality: State (that is, country) of residence: Further applicants are indicated on another continuation sheet. Form PCT/IPEA/401 (continuation sheet) (16 September 2012) See Notes to the demand form American LegalNet, Inc. www.FormsWorkFlow.com International application No. Sheet No. . . . Box No. III AGENT OR COMMON REPRESENTATIVE; OR ADDRESS FOR CORRESPONDENCE The following person is and agent common representative has been appointed earlier and represents the applicant(s) also for international preliminary examination. is hereby appointed and any earlier appointment of (an) agent(s)/common representative is hereby revoked. is hereby appointed, specifically for the procedure before the International Preliminary Examining Authority, in addition to the agent(s)/common representative appointed earlier. Name and address: (Family name followed by given name; for a legal entity, full official designation. Telephone No. The address must include postal code and name of country.) Facsimile No. Agent’s registration No. with the Office E-mail authorization: Marking one of the check-boxes below authorizes the International 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 if those offices are willing to do so. exclusively in electronic form (no paper notifications will be sent). as advance copies followed by paper notifications; or E-mail address: ___________________________________________________________________________ Address for correspondence: Mark this check-box where no agent or common representative is/has been appointed and the space above is used instead to indicate a special address to which correspondence should be sent. Box No. IV BASIS FOR INTERNATIONAL PRELIMINARY EXAMINATION Statement concerning amendments:* 1. The applicant wishes the international preliminary examination to start on the basis of: the international application as originally filed the description as originally filed as amended under Article 34 the claims as originally filed as amended under Article 19 as amended under Article 34 the drawings as originally filed as amended under Article 34 2. The applicant wishes any amendment to the claims under Article 19 to be considered as reversed. 3. Where the IPEA wishes to start the international preliminary examination at the same time as the international search in accordance with Rule 69.1(b), the applicant requests the IPEA to postpone the start of the international preliminary examination until the expiration of the applicable time limit under Rule 69.1(d). The applicant expressly wishes the international preliminary examination to start earlier than at the expiration of the applicable time limit under Rule 54bis.1(a). 4. * Where no check-box is marked, international preliminary examination will start on the basis of the international application as originally filed or, where a copy of amendments to the claims under Article 19 and/or amendments of the international application under Article 34 are received by the International Preliminary Examining Authority before it has begun to draw up a written opinion or the international preliminary examination report, as so amended. Language for the purposes of international preliminary examination: _______________________________________________ which is the language in which the international application was filed. which is the language of a translation furnished for the purposes of international search. which is the language of publication of the international application. which is the language of the translation (to be) furnished for the purposes of international preliminary examination. Box No. V ELECTION OF STATES The filing of this demand constitutes the election of all Contracting States which are designated and are bound by Chapter II of the PCT. Form PCT/IPEA/401 (second sheet) (16 September 2012) See Notes to the demand form American LegalNet, Inc. www.FormsWorkFlow.com International application No. Sheet No. . . . Box No. VI CHECK LIST The demand is accompanied by the following elements, in the language referred to in Box No. IV, for the purposes of international preliminary examination: For International Preliminary Examining Authority use only received 1. translation of international application : 2. amendments under Article 34 : sheets 3. letter accompanying the amendments under Article 34 (Rule 66.8) : sheets 4. copy (or, where required, translation) of amendments under Article 19 : sheets 5. copy of the letter accompanying the amendments under Article 19 (Rules 46.5(b) and 53.9) : sheets 6. copy (or, where applicable, translation) of any statement under Article 19 (Rule 62.1(ii)) : sheets 7. other (specify) : not received sheets sheets The demand is also accompanied by the item(s) marked below: 1. fee calculation sheet 5. sequence listing in electronic form 2. original separate power of attorney 6. 3. original general power of attorney 4. copy of general power of attorney; reference number, if any: other (specify): _______________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ Box No. VII SIGNATURE OF APPLICANT, AGENT OR COMMON REPRESENTATIVE Next to each signature, indicate the name of the person signing and the capacity in which the person signs (if such capacity is not obvious from reading the demand). For International Preliminary Examining Authority use only 1. Date of actual receipt of DEMAND: 2. Adjusted date of receipt of demand due to CORRECTIONS under Rule 60.1(b): 4. 5. The date of receipt of the demand is AFTER the expiration of 19 months from the priority date and item 4 or 5, below, does not apply. 6. The date of receipt of the demand is AFTER the expiration of the time limit under Rule 54bis.1(a) and item 7 or 8, below, does not apply. The applicant has been informed accordingly. 3. 7. The date of receipt of the demand is WITHIN the time limit of 19 months from the priority date as extended by virtue of Rule 80.5. Although the date of receipt of the demand is after the expiration of 19 months from the priority date, the delay in arrival is EXCUSED pursuant to Rule 82. The date of receipt of the demand is WITHIN the time limit under Rule 54bis.1(a) as extended by virtue of Rule 80.5. 8. Although the date of receipt of the demand is after the expiration of the time limit under Rule 54bis.1(a), the delay in arrival is EXCUSED pursuant to Rule 82. For International Bureau use only Demand received from IPEA on: Form PCT/IPEA/401 (last sheet) (16 September 2012) See Notes to the demand form American LegalNet, Inc. www.FormsWorkFlow.com